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  • Presentation

Chronic Graft-Versus-Host Disease: Therapeutic Updates

Description

Mike Stevens, a dermatologist at Mass General, discusses chronic graft-versus-host disease (GVHD), focusing on management strategies and treatment updates. He highlights the increasing prevalence of GVHD due to rising bone marrow transplants, emphasizing the need for dermatologists in managing skin manifestations. Limited FDA-approved treatment options exist, primarily corticosteroids, which often lead to steroid-refractory cases. The talk delves into distinguishing chronic GVHD phenotypes: non-sclerotic and sclerotic diseases, with respective diagnostic and treatment approaches. Non-sclerotic disease features a lichen planus-like morphology, while sclerotic disease involves deep tissue fibrosis, necessitating timely diagnosis and intervention. Stevens reviews topical treatments such as steroids, ruxolitinib cream, and others, alongside systemic therapies like ruxolitinib, bellamosidil, and ibrutinib, discussing their efficacy, side effects, and patient-specific considerations. He introduces extracorporeal photophoresis (ECP) and acetilimab, an emerging drug targeting macrophage activity, while noting the potential of dupilumab for atopic-like non-sclerotic conditions. Throughout, he emphasizes a collaborative care model with transplant oncologists, providing a comprehensive treatment algorithm to enhance the management of chronic GVHD.

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Conclusions

  • Chronic graft-versus-host disease (cGVHD) is common among bone marrow transplant recipients and requires effective management strategies.
  • Corticosteroids remain the primary treatment for cGVHD, but many patients have steroid-refractory or steroid-dependent disease.
  • There is a critical need for more effective treatment options for cGVHD beyond current FDA-approved therapies.
  • Topical agents such as ruxolitinib cream show promising results in managing skin manifestations of cGVHD.
  • Systemic therapies like ruxolitinib have demonstrated improved overall response rates compared to standard treatments in cGVHD patients.
  • Belumosidil and ibrutinib are additional systemic therapies showing efficacy in cGVHD treatment, with variable response rates.
  • Extracorporeal photopheresis (ECP) is a valuable adjunct therapy for cGVHD, particularly in patients unresponsive to conventional treatments.
  • Axatilimab has shown potential for treating sclerodermatous cGVHD, though its efficacy and safety profiles need further investigation.
  • Dupilumab may offer benefits for patients with certain cGVHD subtypes, but more data is necessary to define its role comprehensively.
  • Supportive care, including routine skin examinations and pruritus management, is vital for improving patient outcomes in cGVHD.
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  • Martires KJ, Baird K, Steinberg SM, et al. Sclerotic-type chronic GVHD of the skin: clinical risk factors, laboratory markers, and burden of disease. Blood. 2011;118(15):4250-4257.
  • Baumrin E, Loren AW, Falk SJ, Mays JW, Cowen EW. Chronic graft-versus-host disease. Part II: Disease activity grading and therapeutic management. J Am Acad Dermatol. 2024;90(1):19-36.
  • Markova A, Papadopoulos EB, Dusza S, et al. Topical ruxolitinib for chronic cutaneous gvhd: promising results of a phase 2 clinical trial. Blood. 2023;142(Supplement 1):777-777.
  • Braun LM, Zeiser R. Kinase inhibition as treatment for acute and chronic graft-versus-host disease. Front Immunol. 2021;12:760199.
  • Zeiser R, Polverelli N, Ram R, et al. Ruxolitinib for glucocorticoid-refractory chronic graft-versus-host disease. N Engl J Med. 2021;385(3):228-238.