Having become involved in cGVHD and its treatment a long time ago at The University of Texas MD Anderson Cancer Center, then later at the University of Michigan, and now here at the University of Utah, I am a firm believer in the multidisciplinary care setting as a model, owing to both the complexity and the rarity of cGVHD. Individuals with cGVHD need to be treated in an environment with providers who have a lot of experience with this disease.

That environment might include not only an oncologist but also an ophthalmologist, a dermatologist, a pulmonologist, a rheumatologist, a gynecologist, a physical therapist, and many other providers who are experienced with the very particular needs of these patients. We are fortunate to have such resources, including an extraordinary physical therapy group and a physical therapist who is allocated to our blood and marrow transplant group. Additionally, once per week, we work with the physical rehabilitation group that does consultations with people who require assistance beyond physical therapy.

Another consideration is that, without a system to integrate such care, patients are at risk for delays in treatment that can have serious consequences. Consider a patient with cGVHD who has recently been discharged, begins to experience dry eye, and goes to a local eye doctor who is not familiar with GVHD-related eye disorders. If you are fortunate and the patient’s ophthalmologist calls you right away, then you have been alerted and can act on the problem. But we all know that communication channels in health care do not always work optimally. Whether acute or chronic, GVHD is a very time-sensitive condition, and delays in appropriate treatment can have serious consequences for patients. The patient with GVHD you see today is not the patient you will see in 6 months, and delays can result in a missed window of opportunity.

I would also venture to say that having the right infrastructure to perform allogeneic transplantations should also mean having the infrastructure for GVHD care, because approximately one-half of your patients will develop GVHD. Transplants cause morbidity, and centers should be equipped to handle transplant-associated morbidity. The more experience you have as a multidisciplinary team, the better the care you provide for your patients.