{"slug":"gvhd","tag":"gvhd","variants":["gvhd"],"description":"No description yet","count":8,"kinds":{"technology":8},"related":[{"slug":"rejuvenation","tag":"rejuvenation","shared":8},{"slug":"survivorship","tag":"survivorship","shared":8},{"slug":"transplant","tag":"transplant","shared":8},{"slug":"treatment","tag":"treatment","shared":3},{"slug":"apheresis","tag":"apheresis","shared":1},{"slug":"grading","tag":"grading","shared":1},{"slug":"immune","tag":"immune","shared":1},{"slug":"lung","tag":"lung","shared":1},{"slug":"organ","tag":"organ","shared":1},{"slug":"prevention","tag":"prevention","shared":1}],"records":[{"id":"gvhd-chronic-overview","kind":"technology","name":"Chronic graft-versus-host disease","route":"/technologies/gvhd-chronic-overview/","status":"established","tldr":"After a donor transplant the new immune system can treat the body it has landed in as foreign. When that goes on past the first few months it is called chronic graft-versus-host disease, and it affects roughly four in ten adults. It is treatable and often improves, and the same donor immunity also keeps the leukaemia away, so the aim is to control it rather than abolish it."},{"id":"gvhd-nih-consensus-criteria","kind":"technology","name":"How chronic GvHD is diagnosed and scored: the NIH consensus criteria","route":"/technologies/gvhd-nih-consensus-criteria/","status":"established","tldr":"There is an agreed way to say how bad chronic GvHD is, and every trial, drug label and treatment decision uses it. Each affected organ scores 0 to 3, and the pattern gives an overall verdict of mild, moderate or severe. Worth asking: which organs are scored, what each score is, and what the global severity is."},{"id":"gvhd-organ-by-organ","kind":"technology","name":"Chronic GvHD organ by organ: skin, mouth, eyes, gut, liver, joints and genital tract","route":"/technologies/gvhd-organ-by-organ/","status":"established","tldr":"Chronic GvHD is a pattern of injuries that can appear in several places at once: skin that thickens, a dry sore mouth, dry painful eyes, difficulty swallowing, abnormal liver tests, stiff joints, genital narrowing. Several of the best treatments are local rather than systemic. The eye and genital problems are the ones least often raised."},{"id":"gvhd-lung-bronchiolitis-obliterans","kind":"technology","name":"The lungs after transplant: bronchiolitis obliterans syndrome","route":"/technologies/gvhd-lung-bronchiolitis-obliterans/","status":"established","tldr":"The smallest airways in the lung can scar shut after a donor transplant. It is the form of chronic GvHD that changes the outlook most, and it is usually silent until a lot of lung function has gone. It is found by breathing tests on a schedule rather than by waiting for breathlessness, so asking for spirometry is worth doing."},{"id":"gvhd-prophylaxis","kind":"technology","name":"Preventing graft-versus-host disease, and what prevention costs","route":"/technologies/gvhd-prophylaxis/","status":"standard-of-care","tldr":"Every donor transplant includes drugs to stop the new immune system attacking the body. A randomised trial in 2023 changed the usual choice: cyclophosphamide after the transplant, with tacrolimus and mycophenolate, worked better than the older combination. Prevention is not free, because the same drugs hold back the response to infection."},{"id":"gvhd-ruxolitinib-steroid-refractory","kind":"technology","name":"When steroids fail: ruxolitinib for steroid-refractory GvHD","route":"/technologies/gvhd-ruxolitinib-steroid-refractory/","status":"approved","tldr":"First treatment for graft-versus-host disease is steroids, and in about half of people with chronic disease they do not work or cannot be reduced. Ruxolitinib is the only drug that has beaten the alternatives in a randomised trial here, and it has done so twice. About half of people respond; the common problems are low platelets and low haemoglobin."},{"id":"gvhd-belumosudil-axatilimab-ibrutinib","kind":"technology","name":"After ruxolitinib: belumosudil, axatilimab and ibrutinib in chronic GvHD","route":"/technologies/gvhd-belumosudil-axatilimab-ibrutinib/","status":"approved","tldr":"Three more drugs are licensed for chronic GvHD that has not responded to earlier treatment. Their response rates look high, between half and three quarters, but they come from trials with no comparison group. Ibrutinib is the cautionary case: it looked good in a single-arm study and then did not beat prednisone alone when tested against placebo."},{"id":"gvhd-photopheresis","kind":"technology","name":"Extracorporeal photopheresis for graft-versus-host disease","route":"/technologies/gvhd-photopheresis/","status":"established","tldr":"Blood is taken out through a machine, the white cells are treated with a light-sensitive drug and ultraviolet light, and given back. It is used for GvHD that steroids have not controlled, mainly skin and mouth, and it spares people more immunosuppression. Improvement builds over months, so it means two sessions a week for a long time."}]}