Transcript:
Bonnie J. Dirr, APRN: Dr Gooptu, can you also talk to us about other available frontline treatment options for patients with chronic graft-vs-host disease [GHVD]? Do you always rely upon steroids or topical agents, or do you also consider inhaled products and/or clinical trials? We see here in CB’s case for his acute and chronic graft-vs-host disease, you used both corticosteroids for chronic and for acute. Can you highlight the differences in some of the other agents that you tap into in terms of other therapies for chronic graft-vs-host disease?

Mahasweta Gooptu, MD: In the frontline setting, as it turns out, the frontline go-to regimen would still be corticosteroids for acute for as for chronic GVHD. We tend to give lower doses of steroids in chronic GVHD. You perhaps don’t need such a high dose, and you will likely have to continue the therapy for a longer period. Keeping that in mind, I usually start at the lowest they can possibly get away with for frontline treatment. There are, however, effective topical therapies that we can use. For the eyes, things like Restasis [cyclosporine] or steroid eye drops; our ophthalmology colleagues have a slew of other interventions that they use which are very effective. For oral chronic GVHD, steroid rinses are extremely effective, sometimes far more effective, actually, than systemic therapy. Similarly, you have topical steroids for the skin. We counsel them on exercise regimens because physical therapy helps a lot with some of the flexibility issues. But in terms of drugs, the 2 important drugs which have been approved for chronic GVHD in the last few years, as well as other drugs which are showing great promise, they are all really used in the steroid refractory setting. They have not yet made it to front line. But as our understanding of chronic GVHD battle physiology tells us that the earlier you institute treatment, the more you’re likely to get out of it. Moving the drugs we used to [use] in the steroid refractory setting up to the front line is definitely one of the goals for the next decade. But for now, the frontline systemic therapy is still corticosteroids.

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