Dr. Neumann on Tapering Steroids in cGVHD

Joyce L. Neumann, PhD, APRN, AOCN, BMTCN, FAAN, program director, Stem Cell Transplantation and Cellular Therapy, adjuvant ethicist, Section of Integrated Ethics, The University of Texas MD Anderson Cancer Center, discusses tapering steroids for patients with chronic graft-vs-host disease (cGVHD).

Depending on a patient’s disease presentation, a newer agent, such as ruxolitinib (Jakafi), may be introduced to the treatment plan to control symptoms while the patient is receiving steroids as bridging therapy, Neumann explains. In those situations, the steroids may be tapered more quickly than if steroids were being given as a primary treatment. However, as the patient begins the novel agent, the steroids may be slowly tapered to avoid abruptly stopping a treatment, Neumann adds.

Ultimately, tapering patients off steroids is a main goal of treatment for cGVHD, but patients who abruptly stop steroids may have a cGVHD flare, Neumann explains. Sometimes, cGVHD can be controlled with minimal interventions, but during a flare, the patient can develop symptoms quickly.

Utilizing low-dose immunosuppressant agents is necessary in cGVHD as infections are associated with a high risk of morbidity and mortality in this patient population, Neumann concludes.