HCI LEAP: Graft vs Host Disease. CE Eligible until 11/20/2025
Updated: February 25, 2025
Summary
The video provides a comprehensive overview of graft-versus-host disease (GVHD) in the context of bone marrow transplants. It covers the pathophysiology, diagnosis, symptoms, staging criteria, treatment options including prophylactic regimens and novel therapies, as well as considerations for managing steroid-refractory GVHD. The discussion also touches on the importance of selecting appropriate GVH prophylaxis, minimizing T-cell infusion to reduce chronic GVHD risk, and utilizing mesenchymal stem cells in patient care.
TABLE OF CONTENTS
Introduction and Contact Hours
Definition of GVHD
Background on BMT
Purpose of Transplant
Types of GVHD
Pathophysiology of GVHD
Diagnosis and Symptoms of GVHD
Treatment of GVHD
GVHD Prophylaxis
Steroid Refractory GVHD
Discussion on GVH Prophylaxis
Risk Factors for Cells in the Actual Product
Patient's Case and Treatment
Closure and Appreciation
Introduction and Contact Hours
The video begins with introductions and information on how to earn contact hours. Attendees are reminded to fill out a post-evaluation survey to receive contact hours.
Definition of GVHD
The speaker defines graft-versus-host disease (GVHD) and discusses its pathophysiology and impact on patients.
Background on BMT
Brief background information on bone marrow transplants (BMT), including the different types of stem cells used and the sources of stem cells.
Purpose of Transplant
Exploration of the purpose of a transplant as a rescue from ablative therapy and to overcome drug resistance, with a focus on using donor cells for treatment.
Types of GVHD
Discussion on the types of GVHD, including acute, chronic, and overlap syndrome, along with their characteristics and timing of occurrence.
Pathophysiology of GVHD
Explanation of the pathophysiology of GVHD, detailing how transplanted tissue or stem cells attack the recipient's body and the immune responses involved in the process.
Diagnosis and Symptoms of GVHD
Description of the diagnosis and symptoms of GVHD, including skin, GI tract, liver, and respiratory manifestations, as well as staging criteria for GVHD.
Treatment of GVHD
Overview of GVHD treatment options, including immunosuppressive drugs like tacrolimus and methotrexate, and the use of systemic corticosteroids. Other treatments such as extracorporeal photopheresis (ECP) and novel therapies are also discussed.
GVHD Prophylaxis
Explanation of post-transplant cyclophosphamide as a common prophylactic regimen for GVHD prevention, with a focus on its mechanism of action and effectiveness.
Steroid Refractory GVHD
Information on the treatment of steroid-refractory GVHD, including different therapeutic options and considerations for managing patients with refractory disease.
Discussion on GVH Prophylaxis
The discussion revolves around the benefits and costs of using a specific type of GVH prophylaxis over the standard treatment. Mention of using it in a couple of patients and the risk of GVHD with deceased stem cells is highlighted.
Risk Factors for Cells in the Actual Product
The speaker addresses the topic of using marrow versus stem cells, emphasizing the reduced risk of chronic GVHD when infusing less T-cells into the patient. Factors like HLA mismatched donors are also discussed.
Patient's Case and Treatment
A specific patient's case is brought up, mentioning the use of Jack and the impact on the patient's condition. The discussion delves into gut rest, diarrhea improvement, and the criteria for receiving mesenchymal stem cells.
Closure and Appreciation
The session wraps up with gratitude for participation, a reminder to complete evaluations, and a call to submit feedback. Participants are thanked for their involvement.
FAQ
Q: What is graft-versus-host disease (GVHD)?
A: GVHD is a condition where transplanted tissue or stem cells attack the recipient's body, leading to immune responses and potential complications.
Q: What are the different types of GVHD discussed in the session?
A: The session covers acute GVHD, chronic GVHD, and overlap syndrome, each with distinct characteristics and varying times of occurrence.
Q: What are some symptoms and manifestations of GVHD mentioned?
A: Symptoms include skin issues, gastrointestinal problems, liver complications, respiratory manifestations, and there are specific staging criteria for assessing GVHD severity.
Q: What are some common treatments for GVHD discussed?
A: Treatment options include immunosuppressive drugs like tacrolimus and methotrexate, systemic corticosteroids, extracorporeal photopheresis (ECP), novel therapies, and post-transplant cyclophosphamide for prevention.
Q: Why is post-transplant cyclophosphamide highlighted as a prophylactic regimen for GVHD prevention?
A: Post-transplant cyclophosphamide is discussed due to its mechanism of action and effectiveness in reducing the risk of GVHD post bone marrow transplant.
Q: What considerations are mentioned for managing patients with steroid-refractory GVHD?
A: The session discusses various therapeutic options and approaches for patients with steroid-refractory GVHD, highlighting the challenges and considerations in such cases.
Q: Why is there emphasis on using marrow versus stem cells in the treatment process?
A: The discussion focuses on the reduced risk of chronic GVHD associated with infusing fewer T-cells by using marrow over stem cells, particularly in the context of HLA mismatched donors.
Q: What is the impact of using different types of GVH prophylaxis mentioned in the session?
A: The session mentions benefits and costs associated with specific GVH prophylaxis methods compared to standard treatments, along with risks such as GVHD with deceased stem cells.
Q: What specific case is brought up regarding a patient's treatment?
A: A specific patient case involving the use of Jack, gut rest, diarrhea improvement, and criteria for receiving mesenchymal stem cells is discussed, showcasing a practical application of the discussed treatments.
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