<p>Chronic graft-versus-host-disease (cGVHD) is the primary cause of nonrelapse mortality (NRM) and morbidity after an allogeneic hematopoietic stem cell transplant and significantly impacts patient quality of life (QOL). By identifying risk factors associated with cGVHD-related mortality and morbidity and pinpointing vulnerable patient groups, clinicians can better tailor treatment strategies and adopt a proactive personalized approach, ultimately striving to enhance both survival and QOL.</p>

NRM continues to rise over time in individuals with cGVHD, and, even more than a decade after receiving a transplant, patients are still at a higher risk of NRM. Multiple risk factors have been associated with higher NRM, including the type of cGVHD that a person has. For example, overlap syndrome carries a higher risk of NRM than other forms of cGVHD. Further, older patients who have comorbidities or are more frail are at a higher risk of NRM due to the disease and the therapies that we use. Patients who have certain organ manifestations, including severe lung or skin cGVHD, are also at a higher risk. Elevated bilirubin levels and reduced platelet counts are other risk factors. Finally, concurrent infection, skin ulceration, and chronic wounds related to cGVHD represent major sources of risk too.

 

One of the most challenging aspects of caring for patients with cGVHD is helping them accept that they have a condition that will require treatment and close follow-up at a transplant center. Many times, the initial thoughts of patients who come to me are that I will evaluate them and give them a quick fix so that they can go on with their lives. However, the reality is that a person with moderate to severe cGVHD will likely need prolonged therapy and follow-up. We know by following these patients that a majority of them are going to require long-term immunosuppressive therapy and monitoring, so I think that it is important to temper expectations of a quick fix during the first visit.

 

A clinician’s tasks when caring for patients with cGVHD are really quite significant. We are looking to reduce, or at least stabilize, the organ manifestations and the direct impact of cGVHD. By doing so, we are hoping to improve the patient’s QOL, functional capacity, and ability to do all the things they find important, be it work, social interactions, or family involvement. Therapies for cGVHD are aimed at improving survival and lowering NRM, with the additional goal of not contributing to symptom burden and NRM as a result of infections, organ toxicities, or other long-term side effects.

 

The impact of cGVHD manifestations on a patient’s QOL and ability to do the things they love cannot be understated. Trying to improve organ function, or at least help ameliorate symptoms to improve QOL, is really an integral part of the multidisciplinary approach that is needed to care for these patients. I think that it is very important for patients with cGVHD to be seen at centers that have a diverse team of providers who can focus on organ-specific manifestations and provide the best supportive care and therapies to, ideally, improve their QOL and give them back their joy.