A panel of leading transplant specialists and hematology experts recently convened to discuss the evolving landscape of chronic graft-versus-host disease (GVHD) management, highlighting key challenges and treatment approaches in post-transplant care.
Collaborative Care Model Essential for GVHD Management
Dr. Michael R. Bishop, Director of the Hematopoietic Stem Cell Transplantation Program at UChicago Medicine, emphasized the crucial need for collaboration between transplant centers and referring physicians. With approximately 40,000 allogeneic transplants performed annually in the United States, ensuring proper follow-up care has become increasingly important.
"The joint collaboration between referring physicians and the transplant center is imperative," stated Dr. Bishop. This partnership becomes particularly vital when patients face difficulties returning to transplant centers due to social or physical barriers.
REACH3 Trial Insights: Managing Expectations with Ruxolitinib
Discussion of the phase 3 REACH3 trial's three-year data provided important insights into ruxolitinib's role in treating steroid-refractory chronic GVHD. Dr. Rachel Phelan noted that while many patients respond to treatment, complete response rates remain relatively low.
"What I maybe didn't fully realize before is the complete response versus partial responses, where the CR rate is quite small," Dr. Phelan observed. "That's important to know in terms of expectations."
Treatment Selection and Patient-Specific Considerations
The experts outlined multiple factors influencing treatment choices for steroid-refractory or steroid-dependent chronic GVHD. Key considerations include:
- Disease severity and organ involvement
- Patient blood count status, particularly thrombocytopenia
- Insurance approval and access to patient support programs
- Potential for combination therapy approaches
Emerging Treatment Options and Challenges
The panel discussed various treatment modalities, including:
- Extracorporeal photopheresis (ECP)
- Rituximab
- Ibrutinib
- Belumosudil
Dr. William Tse highlighted the potential benefits of combination approaches, particularly regarding steroid-sparing strategies. "The combination [enabled patients to] much more successfully and rapidly taper off the steroid," he noted.
Special Considerations in Pediatric GVHD
Dr. Phelan addressed unique challenges in pediatric GVHD management, including:
- Medication formulation requirements (liquid vs. pill form)
- FDA approval limitations for younger patients
- Compliance and follow-up challenges with young adult patients
The experts concluded by emphasizing the importance of individualized treatment approaches and the need for continued research to optimize outcomes for chronic GVHD patients.
