Dr Bernice Kwong Discusses Impact of Delayed Diagnosis, Treatment for GVHD

Bernice Kwong, MD, clinical professor of dermatology, Stanford University, talks about how later diagnosis and treatment for graft-versus-host disease (GVHD) affects disease progression and overall patient outcomes, as well as her hopes for the future of GVHD treatment.

Transcript

How does later diagnosis and initiation to treatment affect disease progression and overall patient outcomes in GVHD?

The later a patient has intervention for the graft-versus-host disease, the more immunosuppression they probably have had along the way. Especially if it's refractory graft-versus-host disease. When it's being managed, they're going to have layering on of additional immunosuppressive medications, which have many side effects, not just immunosuppression, which in and of itself can harm a patient or cause mortality or morbidity. But each of these medications can have toxicities to internal organs or interact with other medications. Even in the end of the day, if it's more pills for a patient to take or infusions, it's a lot to ask for patients. So, the earlier that we can intervene, the better.

Our hope is that, through dermatology, if we can figure out how to optimize skin-directed care and make the right diagnoses, that we can help to heal the skin so that immunosuppression can start being tapered sooner. The later that happens, the longer we imagine patients are on systemic medications that can be very helpful but have their own toxicities as well.

What treatments do you hope to see available for patients with GVHD in the near future?

I hope that, for GVHD, our future brings us more personalized and elegant treatment modalities for each individual patient, because I think GVHD is lumped into these big categories right now. You see some patients and, if they're lucky, they get better on this certain medication. And then some don't, and it's the same medication, even though their skin looks the same. That tells us and me that there are more layers to this than we know about and [prompts] investigation into what is it that's unique in this patient, and then, because of that, what of these many, many medications that we have would be the best fit for this patient because of their unique pattern that they're expressing.

I think that's a lot of work. We have to understand so many molecular things—genetics—and there are so many things that I don't even know about that we haven't discovered yet. But my hope is that there is just a much more personalized approach through combination of all sorts of genetic or other biomarkers that can help us to choose, more quickly, the right medication for a patient rather than watching them cycle through month after month and year after year until this right combination. Because, by the point that happens, so many have had so much cumulative toxicity from the disease and medications that they do poorly.

So, my hope is faster, more personalized treatment for them.