TY - CHAP M1 - Book, Section TI - Immunopharmacology A1 - Lake, Douglas F. A1 - Briggs, Adrienne D. A2 - Katzung, Bertram G. A2 - Vanderah, Todd W. Y1 - 2021 N1 - T2 - Basic & Clinical Pharmacology, 15e AB - CASE STUDYA 59-year-old woman with myelodysplastic syndrome undergoes high-dose chemotherapy followed by an allogeneic stem cell transplant from an unrelated donor. She receives tacrolimus and low-dose methotrexate as prophylaxis for graft-versus-host disease (GVHD). One month after blood count recovery, she develops a skin rash despite ongoing tacrolimus therapy. A skin biopsy confirms grade II acute GVHD. She is placed on 1 mg/kg/d of prednisone, but 1 week later her rash is worse. Her liver enzymes are elevated, and she is having voluminous bloody diarrhea. Endoscopic biopsy of upper and lower gut shows grade IV acute GVHD. The patient is put on high-dose methylprednisolone for 5 days without symptom improvement. What is the next step in managing this complex patient? SN - PB - McGraw-Hill CY - New York, NY Y2 - 2024/03/28 UR - accesspharmacy.mhmedical.com/content.aspx?aid=1176470987 ER -