Management of acute GVHD. 1Patients with grade IIa GVHD may respond to MP, 1 mg/kg, possibly combined with beclomethasone, 1-2 mg 4 times a day, and budesonide, 3 mg twice a day. In patients with grades IIb to IV GVHD, the starting dose of MP should probably be 2 mg/kg (with or without the addition of beclomethasone and budesonide). (Grade IIa is defined as skin rash of < 50% body surface area, not progressing rapidly within the first day; bilirubin < 3 mg/dL; < 20 mL nonhemorrhagic diarrhea/kg per day, without abdominal cramping. Grades IIb-IV include all cases outside the parameters defined for grade IIa.) 2The decision will likely depend upon the timing of the GVHD flare and the clinical presentation of the disease.20 Illustration by A. Y. Chen and H. Crawford.
