Upgrades in Understanding Therapeutic Strategies for Graft-Versus-Host Disease

An educational enduring online activity provided by i3 Health has provided efficiency and knowledge gains encompassing the evolving landscape of therapeutic strategies for graft-versus-host disease (GVHD).

Graft-versus-host disease is a complication of allogeneic hematopoietic stem cell transplant (HSCT), affecting between 40% and 60% of patients and accounting for 15% of posttransplant mortality. Acute GVHD is the second-leading cause of transplant-related mortality and typically targets the skin, gastrointestinal tract, and liver. Chronic GVHD often presents during the first year following HSCT but may develop in subsequent years and most commonly affects the skin. In recent years, advances in the management of other HSCT-related complications have led to reductions in mortality. However, despite intensive research, GVHD remains a challenge due to its heterogeneity and complex pathogenesis, as well as a lack of well-defined therapeutic strategies.

To address the knowledge gaps experienced by medical professionals surrounding up-to-date therapeutic strategies for GVHD, i3 Health provided a continuing medical education (CME)– and nursing continuing professional development (NCPD)–approved online enduring activity, Understanding Evolving Therapeutic Strategies for Graft-Versus-Host Disease, chaired by Corey Cutler, MD, MPH, FRCPC, Medical Director of the Adult Stem Cell Transplantation Program at Dana-Farber Cancer Institute. This activity was supported by an independent educational grant from Incyte.

The activity was available on i3 Health’s website from January 29, 2021, until January 28, 2022, and saw a total of 792 learners, with 574 moving on to complete the activity for credit. Most learners were registered nurses (91.8%), followed by advanced practice nurses (3.5%), nurse practitioners (1.7%), physicians (1.2%), clinical nurse specialists (0.9%), physician assistants (0.7%), and those who chose “other” as their profession (0.2%).

The baseline data collected revealed knowledge gaps in the following areas: assessing criteria to diagnose acute and chronic GVHD; assessing criteria to appropriately stage and grade acute and chronic GVHD; differentiating prophylactic strategies for patients undergoing HSCT at high risk for GVHD; and applying emerging data and guideline recommendations in individualized treatment plans for patients with acute and chronic GVHD.

The pretest, administered prior to starting the activity, revealed significant knowledge gaps. Only 19% of learners understood that symptoms of acute GVHD can still appear 100 days after transplant; 46% understood the clinical signs of grade 3 acute GVHD according to the Modified Glucksberg scale; 15% understood that, according to the National Institutes of Health (NIH) Consensus Criteria, a patient with chronic GVHD who presents with bronchiolitis obliterans diagnosed with lung biopsy has a moderate (b) staging of chronic GVHD; 57% understood that tacrolimus/methotrexate would most likely be the most effective FDA-approved GVHD prophylaxis regimen for a patient receiving allogeneic HSCT for MDS; 13% understood that T-cell depletion should reduce the chance of grade 2 to 4 acute GVHD, but also may increase the probability of relapse and decrease progression-free and overall survival for a patient receiving allogeneic HSCT for CLL; 81% understood that ruxolitinib is more likely to produce a durable response compared with other standard options for steroid-refractory acute GVHD; and 62% understood that a patient with chronic GVHD that is refractory to both corticosteroids and ibrutinib would be likely to achieve a response with belumosudil.

Significant learning took place throughout the activity as was revealed by the posttest data: 71% more learners understood symptoms and diagnosis of GVHD; 50% more understood grading of GVHD; 60% more understood staging of GVHD; 38% more understood selection of GVHD prophylaxis regimens; 62% more understood the disadvantages of T-cell depletion for acute GVHD; 16% more understood ruxolitinib efficacy for steroid-refractory acute GVHD; and 31% more understood belumosudil efficacy for chronic GVHD.

Upon completion, 88% of learners felt more confident in treating their patients with GVHD, and 88% felt that the material presented would be used to improve the outcomes of their patients.

The data revealed by the posttest assessment affirm the effectiveness of the online educational content and show significant knowledge gains regarding up-to-date therapeutic strategies for GVHD. i3 Health has determined that the multidisciplinary team may benefit from CME/NCPD activities that provide GVHD education on assessing criteria to diagnose, grade, and stage GVHD, prophylactic strategies to reduce the risk of GVHD, and emerging data and guideline recommendations to inform treatment plans and management.


i3 Health (2022). Understanding evolving therapeutic strategies for graft-versus-host disease: activity outcomes report. Data on file. 

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