Final Thoughts: GVHD

EP: 1.Immunopathology and GVHD Incidence

EP: 2.GVHD Prophylaxis

EP: 3.Diagnosing & Staging of GVHD

EP: 4.Management of Acute GVHD

EP: 5.Management of Chronic GVHD

EP: 6.Steroid Refractory GVHD: Scope of the Problem

EP: 7.Steroid-Refractory Acute GVHD

EP: 8.Steroid-Refractory Chronic GVHD

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EP: 9.Final Thoughts: GVHD

Yin-Bin Chen, MD: That concludes our session here today. I want to thank all my colleagues here for this enriching and informative discussion, and for taking the time out of their schedules to talk about a problem that we all deal with on a daily basis. Before we conclude, I’d like to give everybody the opportunity to give their final thoughts. I will frame it as what you guys are looking out for in the next 2 years in any part of acute or chronic GVHD [graft-vs-host disease] research or trials. We will start with Corey.

Corey Cutler, MD, PhD, FRCPC: We have all made tremendous progress in the last couple of years. I’m hoping that we run with this head of steam. I think we’re going to see more drugs and more trials come out in terms of results. Hopefully, there will be more approvals so we’ll have a larger quiver of arrows to use on our patients.

Yin-Bin Chen, MD: Rich?

Richard Maziarz, MD: I would agree. There is some interesting work that we didn’t even touch on; some of the new selective graft engineering. We have to deal with costs of care and costs of procedure. With some of these new studies and new approaches with selective depletion of naïve populations of T cells, it may be important in GVHD. The early addition of regulatory T cells may be important for GVHD as well. I expect in the next 2 to 3 years, we will see answers. My personal curiosity is what will happen with pediatric steroid-refractory GVHD. It’s interesting that there’s a single-arm phase 3 randomized against historical control that was published and was positive for …. stem cell. We are still waiting to hear if the FDA will grant approval. That could rejuvenate this stromal cell population. Again, like everything, the cost of the intervention is going to dictate how we can build it into our therapeutic selections.

Yin-Bin Chen, MD: Sophie?

Sophie Paczesny, MD, PhD:I hope that we get better biomarkers. We are working on it to restratify, even if they are not perfect and we cannot expect 90% specificity and sensitivity. But even if the AUC [area under the curve] is at 0.70 or 0.75; they are worth to try and to use correctly. The cutoff must be evaluated in prospective studies and this type of thing for a specific outcome. We will get there, even for chronic GVHD.

Yin-Bin Chen, MD: I agree with my colleagues. This is an exciting time in graft-vs-host disease research. We are all grateful for the level of investment from not only our colleagues and the collaboration, but also our partners in industry who have allowed a lot of this research to move forward. We hope this keeps going and we can continue to make progress, ultimately for the benefit of our patients. Thank you to our audience as well. We hope you all found this peer exchange discussion to be engaging and helpful to your management of transplant patients with graft-vs-host disease. Take care.

Transcript edited for clarity.