NCCN News

New Resource From NCCN Shares Evidence-Based Approaches to Recognize and Manage Graft-Versus-Host Disease After Stem Cell Transplantation

NCCN has announced the publication of new NCCN Guidelines for Patients: Graft-Versus-Host Disease (GVHD). GVHD is a complication that occurs after a donor stem cell or bone marrow (ie, hematopoietic) transplant—which is used to cure some types of blood cancers. One goal of donor hematopoietic cell transplants is for the donor’s immune cells to attack the cancerous cells, an important contributor to achieving a cure. When GVHD occurs, the transplanted donor cells attack the patient’s healthy body tissues, causing mild or severe symptoms. Incidences of acute and chronic GVHD continue to be significant in the United States, in particular with the increasing use of incompletely matched donors—meaning the healthy cells are donated from a someone who is not a perfect tissue-type (also known as HLA) match.1

“GVHD is a transplant complication that comes as a surprise for many patients,” said Susan Stewart, Executive Director, BMT InfoNet and 32-year bone marrow transplant survivor. “It can significantly impact a patient’s quality of life, particularly if it persists long-term. Knowing the symptoms, so that it can be caught early—as well as potential treatment options—is crucial for GVHD patients.”

“Anyone who undergoes stem cell transplantation from a donor should be aware of the possibility of acute or chronic GVHD, which arises when the donor immune cells see host tissues as foreign, and attack them,” said Ayman A. Saad, MD, Professor of Internal Medicine, The Ohio State University Comprehensive Cancer Center–Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Chair of the NCCN Guidelines Panel for Hematopoietic Cell Transplantation. “The symptoms can be very tricky and manifest suddenly, in unusual ways, sometimes years after the transplant. The NCCN Guidelines for Patients: GVHD clearly explains this complicated process and hopefully helps people understand the variety of therapies that can be used to treat it.”

“The most important piece of advice is to take GVHD seriously, but not panic,” said Alison W. Loren, MD, MSCE, Director, Blood & Marrow Transplant, Cell Therapy & Transplant Program, Abramson Cancer Center of the University of Pennsylvania, Vice Chair of the NCCN Guidelines Panel for Hematopoietic Cell Transplantation. “GVHD is very common yet poorly understood, even by physicians. Hopefully, this book brings some order to the chaos by sharing evidence and uniformity. Treatment guidelines, if used effectively, will limit the severity and duration of people suffering from GVHD.”

Drs. Saad and Loren stressed the importance of transplant recipients talking to their doctor about anything that feels different after the procedure, even years later, especially issues including rash, diarrhea, nausea, vomiting, poor appetite, fatigue, jaundice (yellow coloring of the skin and eyes), joint stiffness, mouth sores, and dry eyes or mouth.

GVHD can be life-threatening in rare situations, but certainly can impact quality of life. GVHD may be reversible when addressed early. For years, the main treatment was steroids but recent clinical trials have led to new standards of care. Ongoing research will hopefully further improve techniques for both prevention and cure.

“NCCN believes that the best management of any patient with cancer is a clinical trial,” said Dr. Loren. “Some trials require that patients haven’t received any previous treatment, so it’s important to bring it up right away and not miss the opportunity for the best possible care while also adding to our knowledge about how the immune system works.”

NCCN Guidelines for Patients empower patients and caregivers with an easy-to-read version of the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines)—the recognized standard for clinical direction and policy in cancer care. NCCN Guidelines for Patients feature charts, images, and a glossary of medical terms, and include suggested questions to ask the doctor.

NCCN Guidelines for Patients: GVHD are available for free online at NCCN.org/patientguidelines and via the NCCN Patient Guides for Cancer App, thanks to funding from the NCCN Foundation. The growing library of NCCN Guidelines for Patients includes more than 60 frequently updated books for patients and caregivers covering most major types of cancer, including most types of leukemia and lymphoma. There are additional guides covering cancer-related distress, nausea and vomiting, and survivorship (both healthy living & cancer-related late and long-term effects), plus special considerations for adolescents and young adults across all cancer types.

Learn more and help support these and other resources for people with cancer and their caregivers at NCCN.org/foundation.

Reference

1.

Arai S, Arora M, Wang T, et al. Increasing incidence of chronic graft-versus-host disease in allogeneic transplantation: a report from the Center for International Blood and Marrow Transplant Research. Biol Blood Marrow Transplant 2015;21:266274.

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NCCN Announces Funding for Lung and Thyroid Cancer Quality Projects, in Collaboration With Lilly

The NCCN Oncology Research Program (ORP) recently announced new funding for quality projects to improve patient care and outcomes in lung and thyroid cancers. Funding will be provided through support from Eli Lilly and Company (Lilly).

“The overall goal of this project is to develop innovative healthcare provider and systems performance and quality improvement initiatives to enhance patient care and outcomes in non–small cell lung cancer and thyroid cancer” said Crystal S. Denlinger, MD, Senior Vice President, Chief Scientific Officer, NCCN. “Congratulations to all of these inspiring investigators. We are eager to learn their findings and hope they can be expanded to other practices as well.

The selected projects are:

  • • Waddah Arafat, MD, UT Southwestern Simmons Comprehensive Cancer Center

    • ∘ Harnessing an Electronic Health Record (EHR) Genomics Module to Guide Clinical Decisions for Non–Small Cell Lung Cancer (NSCLC) Care

  • • Grace K. Dy, MD, Roswell Park Comprehensive Cancer Center

    • ∘ Multidisciplinary Workflow Optimization to Overcome Challenges in Biomarker Testing and to Expedite Biomarker-Based Treatment Decisions for Patients With NSCLC

  • • Cristina P. Rodriguez, MD, and Perrin E. Romine, MD, MSc, University of Washington School of Medicine/Seattle Cancer Care Alliance

    • ∘ Streamlining Molecular Profiling of Thyroid Malignancies in an Academic Tertiary Referral Oncology Center and Its Community Satellite Clinics

  • • John Strickler, MD, Duke Cancer Institute

    • ∘ ​Expansion of the Duke Molecular Tumor Board to Community Oncology Sites Across the Southeast to Support Adoption of Comprehensive Genomic Profiling and Biomarker Driven Therapy Selection for Lung and Thyroid Cancer Patients

“Lilly is committed to supporting initiatives that increase the appropriate use of comprehensive biomarker testing in metastatic non–small cell lung cancer and thyroid cancer,” said Anthony N. Sireci, MD, MSc, Vice President, Clinical Biomarkers and Diagnostics Development Loxo Oncology at Lilly. “We are proud to collaborate with NCCN on the selected projects to explore how the proposed innovations can ultimately improve patient care and outcomes.”

Proposals were peer reviewed by a Scientific Review Committee, which consisted of leading expert oncologists from NCCN Member Institutions. It is known that predictive biomarker testing on tumor-derived tissue or circulating tumor DNA (ctDNA) plays an important role in the treatment decision-making process for both metastatic non–small cell lung cancer as well as metastatic thyroid cancers. The goal of this project is to provide funding to study projects that, ultimately, are aimed at helping healthcare professionals deliver the optimal guideline-adherent treatment to each patient at the appropriate time. The selected projects are set to be completed within 2 years. The total amount of grants awarded for this research is approximately $1.2 million.

The NCCN ORP fosters innovation and knowledge discovery that improve the lives of people with cancer and supports preclinical, translational, and clinical research and quality improvement projects in oncology at NCCN Member Institutions. In an effort to improve collaboration in cancer research, the NCCN ORP also maintains a shared resources website, an informed consent database, and points to consider on the best practices for biorepositories, registries, and databases. For more information, visit NCCN.org/orp.

  • 1.

    Arai S, Arora M, Wang T, et al. Increasing incidence of chronic graft-versus-host disease in allogeneic transplantation: a report from the Center for International Blood and Marrow Transplant Research. Biol Blood Marrow Transplant 2015;21:266274.

    • Crossref
    • Search Google Scholar
    • Export Citation
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