Opinion
Video
Phases of Pathophysiology of Chronic GVHD
The expert panel explores the immunological aspects of chronic GVHD, highlighting challenges in simultaneous management, addressing fibrosis, and emphasizing the importance of early intervention in evolving transplant care practices.
This is a video synopsis of a discussion involving Dr Yi-Bin Chen, Director of the Transplant and Cell Therapy Program at Massachusetts General Hospital and Professor of Medicine at Harvard Medical School; Dr Corey Cutler, Director of the Stem Cell Transplant Program at Dana-Farber Cancer Institute and Professor of Medicine at Harvard Medical School; Dr Mitchell Horwitz, Professor of Medicine and Director of the Adult Blood and Marrow Transplant Program at Duke University, and Dr Hannah Choe, Assistant Professor and Director of the Graft-versus-Host-Disease (GVHD) program at Ohio State University.
The panel, led by Dr Yi-Bin Chen, delves into the complex immunological and inflammatory pathways underlying chronic GVHD. Dr Chen outlines three phases of chronic GVHD, starting with early inflammation within weeks of transplant, leading to chronic inflammation and dysregulated immunity. The panel discusses the challenge of simultaneously managing these phases and the predisposition to infection and autoimmune phenomena in affected patients.
The focus shifts to the hallmark of chronic GVHD—fibrosis. Dr Corey Cutler emphasizes the importance of addressing collagen deposition in target organs early, suggesting a potential differentiation in treatment approaches between early inflammatory and later fibrotic phases. However, he acknowledges the simultaneous occurrence of all three phases until late stages.
Dr Mitchell Horwitz adds insights on late-stage fibrosis, suggesting that the impact of inflammation on damaged organs might influence the decision to treat aggressively or allow natural resolution. The discussion underscores the difficulty in assessing the reversibility of fibrotic changes and the ongoing efforts to recognize and treat chronic GVHD earlier.
Dr Yi-Bin Chen emphasizes the need for early intervention with improved treatments to prevent late manifestations of chronic GVHD. The panel acknowledges the evolving challenges in managing chronic GVHD, particularly as transplant care extends to patients remote from transplant centers. The burden of managing chronic GVHD is expected to be increasingly shared among transplant professionals and community colleagues, highlighting the collaborative efforts in providing comprehensive patient care.
Video synopsis is AI-generated and reviewed by OncLive® editorial staff.
