Switching to Second Line Treatment in Chronic GVHD

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 conversation focuses on the treatment of chronic GVHD, particularly the transition from systemic steroids to second-line therapies.

Dr Hannah Choe sheds light on the standardized definitions employed in clinical trials to identify steroid-refractory or steroid-dependent chronic GVHD. These definitions include insufficient responses to specific steroid doses over defined periods or unsuccessful tapering attempts. Dr Choe underscores the challenge posed by the variable dosing of steroids and the difficulty in achieving substantial long-term responses with steroids alone.

Dr Yi-Bin Chen introduces a notable real-world practice where patients, despite showing partial responses by NIH criteria, may find these responses unsatisfactory. This observation underscores the motivation to initiate second-line agents like ruxolitinib and ibrutinib, either to enhance partial responses or to expedite steroid tapering.

Dr Corey Cutler delves into the evolving landscape of chronic GVHD treatment timelines, shaped by the availability of multiple approved agents. He emphasizes the strategy of waiting for maximal steroid response before considering second-line therapies, particularly in the context of deep sclerotic disease where skin remodeling necessitates time. With an increasing number of approved agents and ongoing clinical trials, the decision-making process for treatment timelines in chronic GVHD is undergoing significant transformation.

The panel's discussion illuminates the nuanced approach involved in transitioning from steroids to second-line therapies in chronic GVHD, navigating the balance between clinical trial definitions and the complex realities of patient experiences. The insights shared in this discourse contribute significantly to the evolving understanding and management of chronic graft-versus-host disease.

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