Comprehensive management of a 24-year-old patient with B-cell acute lymphoblastic leukemia post-bone marrow transplant and severe graft-versus-host disease- A case report

A 24-year-old patient with B-cell acute lymphoblastic leukemia underwent high-dose chemotherapy followed by allogeneic bone marrow transplantation (BMT) according to the BMT 2000 protocol. The post-transplant course was complicated by the development of severe, Grade 4 graft-versus-host disease (GVHD), with multiorgan involvement and significant facial disfigurement. This condition not only posed life-threatening challenges but also led to profound psychological and social consequences. Management required a comprehensive, multidisciplinary approach combining long-term immunosuppressive therapy to control immune activity, advanced cosmetic surgical interventions to restore facial form, and supportive care aimed at preserving organ function. Over the course of 5 years, the patient gradually stabilized and reached an asymptomatic state with ongoing immunosuppressive therapy, showing no acute adverse effects. This case emphasizes the complexity of treating advanced GVHD following BMT and highlights the importance of integrating immunologic, cosmetic, and supportive strategies. Sustained multidisciplinary care and long-term follow-up are critical to improving both survival and quality of life in such patients.