Graft versus Host Disease Advances and Challenges in Prevention and Treatment

Summary: Graft-versus-host disease (GVHD) is a common complication after a bone marrow/stem cell transplant using donor cells (allogeneic transplant). This presentation will discuss current techniques to prevent GVHD, new drugs to treat acute and chronic GVHD and clinical trials testing new GVHD therapies.
Presenter: Iskra Pusic MD, MSCI, Washington University School of Medicine
Many thanks to Incyte and Sanofi whose support helped make this Survivorship Symposium possible.
To read the transcript, go to:
bmtinfonet.org/video/graft-ve...
Highlights:
(03:19): There are two types of GVHD: acute and chronic. Both acute and chronic GVHD can occur any time after transplant and sometimes overlap.
(06:09): Symptoms of acute GVHD include a red rash, mouth sores, diarrhea, loss of appetite, nausea and vomiting, and elevated liver enzymes.
(08:58): GVHD could be eliminated by removing the immune cells from the donor collection. However, those same cells attack the cancer, which is called graft-versus-leukemia (GVL), which is a desired effect..
(10:14): Strategies to prevent GVHD include selectively removing immune cells from the donor’s stem cells or adding certain types of T-cells to minimize GVHD and maximize GVL.
(13:40): Post transplant Cyclophosphamide (Cytoxan), or PtCy, reduces the incidence of acute and chronic GVHD but can delay immune system recovery which increases the risk of infection.
(26:32): If steroids fail to control symptoms of acute GVHD, ruxolitinib (Jakafi®) is often used as a second line therapy.
(32:49): Changes in skin, hair, and nails can be symptoms of chronic GVHD along with muscle aches and stiffness, difficulty swallowing, cough or wheezes, vaginal dryness and weight loss along with nausea and diarrhea.
(34:06): The most effective first-line therapy for chronic GVHD is steroids, but only 50% of patients with chronic GVHD cases respond to steroids alone.
(38:42): Clinical trials are necessary to investigate the optimal sequencing of the newer GVHD treatments and the populations in which they will have the best response.
(39:51): Success in treating chronic GVHD can be measured by arresting progression with improved function and quality of life. Chronic long-term medications may be necessary to reach this goal.
May 2024, Part of the Virtual Celebrating a Second Chance at Life Survivorship Symposium 2024
Presentation is 40 minutes long with 19 minutes of Q & A
Key Points:
There are two types of GVHD: acute and chronic. Both can occur any time after transplant and sometimes overlap.
Steroids are the first line of therapy for GVHD. However, steroids are effective in treating chronic GVHD in only 40-50% of patients.
The newest strategies to prevent or treat GVJD include post-transplant cyclophosphamide (PtCy), abatacept (Orencia®), ruxolitinib (Jakafi®), ibrutinib (Imbruvica®) and belumosudil (Rezurock®)
Meet the speaker:
oncology.wustl.edu/people/isk...
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