Summary: Several new therapies have recently been approved to prevent and treat graft-versus-host disease (GVHD) and more are being studied. The new therapies are more effective than the standard GVHD therapies and should result in a lower incidence of GVHD with fewer toxicities for patients, going forward.
Presenter: Marcello Rotta MD, Colorado Blood Cancer Institute, part of the Sarah Cannon Cancer Institute at Presbyterian/St. Luke's Medical Center
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Highlights:
A new, effective strategy to prevent GVHD after a transplant using donor cells (an allogeneic transplant) is to give patients post-transplant cyclophosphamide (Cytoxan®).
Three new drugs have proven more effective than traditional treatments for GVHD when it occurs: JAKAFI® (ruxolitinib). IMBRUVICA® (ibrutinib) and REZUROCK® (belumosudil).
Some of the newer therapies to treat GVHD work without suppressing the patient’s immune system or increasing the risk of infection.
April 2023, Part of the Virtual Celebrating a Second Chance at Life Survivorship Symposium
The presentation is 37 minutes long, including 21 minutes of Q&A
Key Points:
(01:14): The cells provided by a donor for a patient’s stem cell transplant include the donor’s blood-forming stem cells, as well as the donor’s immune cells. The donor's immune cells can attack the recipient and are responsible for graft-versus-host disease.
(03:16): Acute GVHD generally occurs during the first three months after transplant. Chronic graft-versus-host disease typically occurs later and is the most serious long-term complication of a transplant using donor cells (allogeneic transplant).
(08:02): Post-transplant cyclophosphamide (Cytoxan®) is a new treatment that can prevent graft-versus-host disease in more patients than drugs traditionally used.
(13:55): A second to way reduce the incidence of GVHD is to remove the T-cells that cause GVHD from the donor's cells, before giving them to the patient.
(16:09): A promising strategy, called Orca-T, is being studied to reduce the incidence of GVHD while preserving the anti-leukemia effect of the donor cells..
(20:33): Once GVHD occurs, the standard treatment has been steroids, which are successful for only half of patients and can cause serious side effects.
((23:24): IMBRUVICA® (ibrutinib) is an effective treatment for some patients with chronic GVHD, particularly those with very tight or sclerotic skin.
(25:57): JAKAFI® (ruxolitinib) is effective against both acute and chronic graft-versus-host disease, and does not suppress the patient’s immune system.
(29:41): In studies of REZUROCK® (belumosudil), 77% of people with chronic GVHD showed improvement. It also does not suppress the patient’s immune system.
(33:40): Axalitimab is a new drug being studied to block macrophages that also contribute to chronic graft-versus-host disease. The drug is well tolerated, and ongoing clinical trials will determine its effectiveness.
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