Graft-versus-Host Disease Prophylaxis and Management

EP: 1.Role of Allogeneic Transplants in Hematologic Malignancies

EP: 2.Hematologic Malignancies and Transplant Options and Conditioning Regimens Used in Allo-HSCT

EP: 3.Supportive Care Measures for Patients Planning to Receive an Allogenic Transplant

EP: 4.Transplant Complications and Survival Outcomes

EP: 5.Clinical Trial Update: CTN Trial

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EP: 6.Graft-versus-Host Disease Prophylaxis and Management

EP: 7.Patient Case Studies of GvHD

EP: 8.Emerging Cellular Therapies in Hematologic Malignancies

EP: 9.Transplant in the Elderly Population

EP: 10.Toxicity Assessment of Precision-Engineered Allo-HSCT

EP: 11.The Role of Allo-HSCT in Higher-Risk MDS

EP: 12.Investigational Allo-HSCT for Advanced Hematologic Malignancies

EP: 13.The Future of Allo-HSCT and Cellular Therapies

EP: 14.OncLive Peer Exchange on Allo-HSCT: Conclusion of Discussion

This is a video synopsis/summary of a Peer Exchange featuring Miguel-Angel Perales, MD; Nelli Bejanyan, MD; Amandeep Salhotra, MD; and Arpita Gandhi, MD, MS.

The panel discusses the challenges of acute and chronic graft-vs-host disease (GVHD), which remain the major cause of nonrelapse mortality in patients undergoing allogeneic hematopoietic stem cell transplantation (allo-HSCT). Acute GVHD can develop in up to 50% to 60% of patients, while chronic GVHD can be seen in up to 70% of patients, depending on factors such as HLA disparities, use of peripheral blood stem cell grafts, donor and recipient age, conditioning regimen, and graft manipulation. CD34-selected grafts have the lowest rates of chronic GVHD.

Corticosteroids remain the first-line treatment for acute GVHD, with a majority of patients responding to high-dose steroids. Ruxolitinib, an FDA-approved drug, has shown a doubling of response rates in patients with steroid-refractory acute GVHD. Patients who fail both steroids and ruxolitinib are particularly high risk, and more clinical trials are needed to improve their outcomes, potentially by focusing on prophylactic strategies and graft manipulation.

For chronic GVHD, 3 drugs have been approved: ibrutinib, belumosudil, and ruxolitinib. These drugs have shown high response rates in phase 2 studies. However, patients who fail these novel agents require combinations and off-label medications to improve their quality of life. Upcoming data on axatilimab, a monoclonal antibody targeting CSF1R, which targets monocytes and tissue-resident macrophages, may provide another option for patients who progress on other drugs. The challenge lies in sequencing and combining these drugs to improve outcomes.

Video synopsis is AI-generated and reviewed by OncLive® editorial staff.