What’s New in Tackling Graft-Versus-Host Disease?

• August 25, 2021
• Amber Specialty Pharmacy
• Amber Specialty Pharmacy, Transplant

From the cause of Graft-Versus-Host Disease to a new focused treatment, this article delves into the condition in detail.

Graft-versus-host disease (GVHD) can be hard to understand. Patients and providers likely have more questions than answers. For example, what is GVHD? Who gets it? What does it mean? We want to offer some answers to your questions.

The Relationship Between Transplant and GVHD

Graft-versus-host disease can be a serious condition following an allogeneic stem cell transplant. With an allogeneic transplant, the immune cells from a donor often do what our immune cells can’t do – recognize and destroy cancer cells. GVHD occurs when the transplanted donor immune cells (the graft) attack the patient’s healthy cells (the host).

Today, as more lives are saved through transplants, GVHD has become one of the most common side-effects facing a post-transplant patient. GVHD cases range from mild and moderate, to severe. Without medical treatment, it can become a life-threatening condition.

Is Graft-Versus-Host Disease Treatable?

There are two main categories of GVHD; acute graft-versus-host disease and chronic graft-versus-host disease. Each form of GVHD affects different tissues and organs and comes with a range of symptoms.

According to the National Institute of Health (NIH), the timing of symptoms is key in determining acute vs. chronic GVHD. Both forms of GVHD are treatable however, the course of care for acute GVHD is better defined. Research has continued in the fight against chronic GVHD. Finally, after decades of work, progress is being made to combat chronic GVHD.

A Look at Acute GVHD (aGVHD)

Up to 70 percent of transplant patients develop acute GVHD within the first one to three months following a transplant.

Symptoms of aGVHD include:

• A red burning skin rash on the palms of the hands or soles of the feet.
• Nausea, vomiting, abdominal cramps, diarrhea, or loss of appetite. 
• Jaundice or a yellowing of the skin or eyes, meaning that GVHD has injured the liver. 

The initial standard of care for acute GVHD is daily systemic or system-wide steroids. Additional therapies are available to aGVHD patients who are not getting positive results from steroid therapy. Those with mild, skin-only aGVHD usually continue their original transplant medication.

A Better Understanding of Chronic GVHD (cGVHD)

There are roughly 14,000 patients in the United States currently living with chronic GVHD. Roughly 30 -70% of patients receiving an allogeneic transplant develop cGVHD. This condition shows up more than 100 days after an organ transplant. As its name implies, cGVHD can last for years – in some cases a lifetime. Patients with cGVHD, may or may not, have already suffered from acute GVHD. 

Symptoms range from a mild rash to a disabling or even life-threatening condition. Chronic GVHD involves one or more organs. It can affect your skin, eyes, mouth, lungs, muscles, joints, liver, stomach, or intestinal tract.

More specific symptoms of chronic graft-versus-host disease include:

• Eyes – dry, itchy, or painful with blurred vision and difficulty with bright lights.
• Mouth – dry mouth, sensitivity to hot, cold, spicy, and acidic foods. Painful mouth ulcers. Difficulty eating, gum disease, and tooth decay.
• Skin – skin rash, dry, tight, and/or itchy skin, thickening of the skin, or change in skin color.
• Nails – changes in nail texture, hard brittle nails, or nail loss.
• Hair – loss of hair, premature graying, or the loss of body hair. 
• GI tract – loss of appetite, weight loss, nausea, vomiting, diarrhea, and stomach pain.
• Lungs – shortness of breath, persistent cough or wheezing.
• Liver – abdominal swelling, jaundice
• Muscles and Joints – weakness and cramps, stiffness and pain in some joints. 

Chronic GVHD symptoms become worse when immune suppression drugs are decreased. These drugs lower the body’s ability to fight infections. Changes can be sudden, like a new skin rash, or come on slowly over time like nail changes, dry eyes, or stiff muscles. Keep track of any physical changes related to cGVHD. It is important to work with your doctor, pharmacist, and healthcare team if you notice any changes or symptoms.

New Targeted Treatment for Chronic GVHD Brings Hope

Research is changing how we treat and care for cGVHD patients. New treatments for chronic GVHD are now offering relief and reducing symptoms. 

Kadmon Pharmaceuticals, LLC brought a new innovative product to market in August 2021. 

REZUROCK™, formerly known as Belumosudilis, is a new ROCK2 inhibitor. This drug is used for cGVHD patients who are dealing with complications following a stem cell transplant. With a different mechanism of action, REZUROCK™ offers hope to transplant patients suffering from cGVHD.

Specialty Pharmacy’s Role in Helping Patients with GVHD

Amber Specialty Pharmacy began dispensing REZUROCK™ in August 2021. We provide patient support, track adherence, and offer regular follow-up with our patients and providers.

Dispensing new medication like REZUROCK™ offers hope to transplant patients with GVHD. To speak with a member of our Oncology COE team please call us at 888-370-1724. With over 23 years of experience, our headquarters is located in Omaha, Nebraska. We serve patients in all 50 states through our 21 pharmacy locations.