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1. According to the Mount Sinai Acute GVHD International Consortium MAGIC criteria, which is the following correct stage and grade of this patient's acute graft-versus-host disease (aGVHD)? CASE 1-10

A. Skin: 1 (possible); liver: 0 (negative); upper gastrointestinal (GI): 0 (negative); lower GI: 1 (confirmed); overall grade I B. Skin: 1 (possible); liver: 0 (negative); upper GI: 1 (possible); lower GI: 2 (confirmed); overall grade II C. Skin: 1 (possible); liver: 0 (negative); upper GI: 0 (negative); lower GI: 2 (confirmed); overall grade III D. Skin: 1 (confirmed); liver: 0 (negative); upper GI: 1 (possible); lower GI: 3 (confirmed); overall grade III E. Unsure

2. What is the best recommendation for initial treatment of the aGVHD?

A. Budesonide (Entocort) 3 mg 3 times daily B. Methylprednisolone 1 mg/kg/day C. Methylprednisolone 1 mg/kg twice daily and mycophenolate D. Methylprednisolone 1 mg/kg twice daily and triamcinolone topical therapy on upper torso E. Unsure

3. CASE continued:
The patient is changed from fluconazole to posaconazole for invasive fungal infection (IFI) prophylaxis, and budesonide (Entocort EC) 3 mg 3 times daily is added.

Which of the following should also be recommended?

A. Increase tacrolimus dose by 50% B. Decrease tacrolimus dose by 50% C. Check a serum level of budesonide in 4 to 5 days D. Change posaconazole to voriconazole E. Unsure

4. CASE continued:
After being on methylprednisolone for 72 hours, the patient's stool volume increased to 1600 mL/day but he has no further cramping. The skin rash has completely resolved. A serum cytokine panel was completed and showed high levels of interleukin (IL)-2, IL-6, and interferon-γ.

Is this patient's cytokine panel consistent with all the cytokines that are expected to be elevated for his aGVHD?

A. Yes B. No C. Unsure

5. Is this patient classified as steroid refractory at 72 hours?

A. Yes B. No C. Unsure

6. Which of the following should be recommended for this patient?

A. No change in therapy; wait to see if there is any improvement after 7 days of methylprednisolone B. Increase methylprednisolone to 2.5 mg/kg twice daily C. Add infliximab 10 mg/kg weekly x 4 D. Add ruxolitinib 5 mg twice daily E. Unsure

7. CASE continued:
The patient was started on infliximab 10 mg/kg weekly, which had been the standard for that institution. However, 10 days later, after the second dose of infliximab, the patient developed GI bleeding. He has also developed a fever and blood cultures are positive for enterococcus.

Which of the following should be recommended at this time?

A. Changing to ruxolitinib 5 mg twice daily B. Adding alemtuzumb C. Adding basiliximab D. Adding tocilizumab E. Unsure

8. CASE continued:
Ruxolitinib is added at a dose of 5 mg twice daily. The patient had no response in 3 days, so the dose is increased to 10 mg twice daily. After 7 more days, the GI bleeding has stopped and stool volumes have decreased to 1100 mL/day.

Which of the following grade 3/4 toxicities was most common with ruxolitinib in the REACH1 trial?

A. Hypertriglyceridemia B. Anemia C. Thrombocytopenia D. Elevated liver enzymes E. Unsure

9. What was the reason for most discontinuations in the REACH1 trial?

A. Infections B. Myelosuppression C. Thrombosis D. Hypertension E. Unsure

10. Which of the following statements is correct? (Foundation for the Accreditation of Cellular Therapy and the Joint Accreditation Committee of the International Society for Cellular Therapy-European Society for Blood and Marrow Transplantation (FACT-JACIE))

A. Accreditation by (FACT-JACIE) for HSCT programs does not require a pharmacist as part of the multidisciplinary team B. Pharmacists should just be checking chemotherapy orders for transplant patients to make sure of their accuracy C. Intervention goals of HSCT pharmacists should be to provide medication management, maximize patient medication education, and develop evidence-based clinical decision support D. Pharmacists' roles in economics are primarily to develop cost-savings initiatives, since most HSCT are contracted E. Unsure

Evaluation Questions

11. How confident are in your treatment choice for the 46-year-old patient in the questions above?

A. Not at all confident B. Somewhat confident C. Confident D. Highly confident

Maintenance is scheduled for 8/7/2023 7:00 AM EST - 8:00 AM EST.

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1. According to the Mount Sinai Acute GVHD International Consortium MAGIC criteria, which is the following correct stage and grade of this patient's acute graft-versus-host disease (aGVHD)? CASE 1-10

2. What is the best recommendation for initial treatment of the aGVHD?

3. CASE continued:
The patient is changed from fluconazole to posaconazole for invasive fungal infection (IFI) prophylaxis, and budesonide (Entocort EC) 3 mg 3 times daily is added.

Which of the following should also be recommended?

5. Is this patient classified as steroid refractory at 72 hours?

6. Which of the following should be recommended for this patient?

9. What was the reason for most discontinuations in the REACH1 trial?

10. Which of the following statements is correct? (Foundation for the Accreditation of Cellular Therapy and the Joint Accreditation Committee of the International Society for Cellular Therapy-European Society for Blood and Marrow Transplantation (FACT-JACIE))

Evaluation Questions

11. How confident are in your treatment choice for the 46-year-old patient in the questions above?

« Return to Activity

Maintenance is scheduled for 8/7/2023 7:00 AM EST - 8:00 AM EST.

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1. According to the Mount Sinai Acute GVHD International Consortium MAGIC criteria, which is the following correct stage and grade of this patient's acute graft-versus-host disease (aGVHD)? CASE 1-10

2. What is the best recommendation for initial treatment of the aGVHD?

3. CASE continued: The patient is changed from fluconazole to posaconazole for invasive fungal infection (IFI) prophylaxis, and budesonide (Entocort EC) 3 mg 3 times daily is added. Which of the following should also be recommended?

5. Is this patient classified as steroid refractory at 72 hours?

6. Which of the following should be recommended for this patient?

9. What was the reason for most discontinuations in the REACH1 trial?

10. Which of the following statements is correct? (Foundation for the Accreditation of Cellular Therapy and the Joint Accreditation Committee of the International Society for Cellular Therapy-European Society for Blood and Marrow Transplantation (FACT-JACIE))

Evaluation Questions

11. How confident are in your treatment choice for the 46-year-old patient in the questions above?

« Return to Activity

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3. CASE continued:
The patient is changed from fluconazole to posaconazole for invasive fungal infection (IFI) prophylaxis, and budesonide (Entocort EC) 3 mg 3 times daily is added.

Which of the following should also be recommended?