How is multidisciplinary care used for graft versus host disease?
A multidisciplinary team in health care is a group of professionals from different disciplines who collaborate to provide comprehensive and coordinated care to patients.
So multidisciplinary care is something that we see more for the later form of GvHD, chronic graft versus host disease.
And I'm very proud of our team that we have here, Memorial Sloan Kettering. We have developed a clinic where we have all these specialists sitting together in the same room that patients come in, and we all see them in the same day, and we're all talking together. Not every center has that, that type of luxury to be able to do that.
So many times they're referring patients out to see a lung specialist, out to see a dentist, out to see a GI specialist, if they have concerns about those different organs being involved with chronic graft versus host disease.
So many of these manifestations of chronic graft versus host disease and these different organs act a lot like autoimmune diseases that we can see in other people that haven't had transplants. So sometimes that expertise from these other doctors can come into play with helping us with some symptomatic management and things like that.
But sometimes they also do additional testing or a specialized interpretation of testing or examinations that I don't have the skill and the expertise in doing so. I have to rely on their expertise to help with managing these patients.
So, specialists that see all the different organs that can be involved typically can be involved for any patient where there's concerns of chronic graft versus host disease, involvement of those organs.
So ophthalmologists can look at the eyes. Dentistry or oral surgery for the mouth, gynecology for vulva, vaginal graft versus host disease. In urology for any concerns for penile graft versus host disease. The GI doctor can help us with the GI tract. We're from the esophagus all the way down, including the liver. And the dentist helps us with the oral care and oral cavity as well.
Dermatology is very often involved because the skin is the most frequently involved organ for many of our patients who have chronic graft versus host disease. So all these doctors are weighing in and assessing one, how severely affected is this organ being involved or attacked by this chronic graft versus host disease?
Two, do we have local therapies that we can use to try to help treat right at the source for these chronic graft versus host issues that may help us with being able to come off of the systemic medicine. So either pills or IV medicines that we use to treat chronic graft versus host disease.
Because if we could treat locally, we have less likelihood for side effects or interactions with other medicines. We'll also have less of a concern for local therapies weakening the immune system and putting us at risk for infection as well.
Local therapy for chronic graft versus host disease refers to treatments that target a specific area of the body rather than the whole body. Examples include topical creams or ointments for skin involvement. Eyedrops for ocular GvHD. Mouth rinses or gels for oral GvHD. Inhaled medications for lung involvement. The idea is to treat symptoms in a localized area while minimizing systemic side effects from medications like steroids that affect the whole body.
So it’s a very broad village of people. They're there at the ready to help take care of these children. Now, in an ideal world, we don't need to engage additional specialists, because the child isn't having any of these complications.
But we know that there is significant risk for these complications, which is why we don't take every single patient to transplant. We only take patients to transplant that we think that we need that type of immunotherapy in order to cure their cancer, because chemotherapy alone is not going to be enough.
So because of that, we only take patients that we need to do transplant because of these risks for graft versus host disease and all of the toxicity intensity of the chemotherapy that we give them. And then the risks of that new immune system coming into their body, and the risk of it not playing well with the body that happened after transplant.