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Published on: March 17, 2020
Navigating the Complexity of Chronic Graft-vs-Host Disease: Canadian Insights into Real-World Treatment Sequencing
Dennis Kim1, Minakshi Taparia2, Erika Robinson3
1Princess Margaret Cancer Center, Toronto, Ontario, Canada.
Insights
Corticosteroids are the initial treatment for chronic graft-versus-host disease (cGVHD). Ruxolitinib is a common second-line therapy, but many patients require multiple treatments, especially those with scleroderma, highlighting the need for better options.
Area of Science:
- Hematology
- Immunology
- Oncology
Background:
- Chronic graft-versus-host disease (cGVHD) is a serious complication following allogeneic hematopoietic cell transplant (HCT).
- Standard first-line treatment involves corticosteroids, but optimal subsequent treatment sequences remain unclear.
- This study addresses the need to understand real-world treatment patterns for cGVHD.
Purpose of the Study:
- To investigate real-world treatment sequencing for chronic graft-versus-host disease (cGVHD).
- To identify common treatment patterns and lines of therapy (LOT) in cGVHD patients.
- To explore associations between specific cGVHD complications and treatment intensity.
Main Methods:
- Retrospective analysis of 77 adult patients with cGVHD who received systemic treatment across 7 Canadian centers.
- Inclusion criteria: allogeneic HCT >18 months prior, diagnosed cGVHD, and systemic treatment including extracorporeal photopheresis (ECP).
- Data collected on patient demographics, treatments received, and complications.
Main Results:
- Corticosteroids were the most frequent initial treatment for cGVHD.
- Ruxolitinib was the most utilized second-line therapy, with 47% of patients on active treatment using it.
- Approximately 40% of patients received more than two lines of therapy, with scleroderma significantly associated with higher treatment intensity (≥3 LOT).
Conclusions:
- Current treatment strategies often require multiple lines of therapy for cGVHD, particularly for patients with scleroderma.
- Ruxolitinib is a key second-line agent, but a substantial proportion of patients progress to further treatments.
- There is an unmet need for more effective therapeutic options to manage refractory cGVHD and its complications.
Background:
Graft-vs-Host Disease (GVHD) is a donor immune-mediated syndrome occurring in patients who undergo an allogeneic hematopoietic cell transplant (HCT). Chronic GVHD (cGVHD) presents with complications of variable severity. Corticosteroids are standard first-line (1L) treatment, but the sequence after 1L is unclear with the availability of new treatments. This research aimed to understand real-world treatment sequencing for cGVHD.
Methods:
This retrospective study investigated adult patients across 7 treatment sites in Canada who had received an allogeneic HCT >18 months prior to the study, experienced cGVHD, and received systemic treatment, including extracorporeal photopheresis (ECP).
Results:
A total of 77 cases were reviewed retrospectively (median age = 51 (IQR 41-62), 51% female). 59 patients remained on active systemic treatment, and among this group, the most common treatments in use were corticosteroids (47%) and ruxolitinib (47%). One patient died, and 17 patients were on non-systemic treatment after complications resolved. The median lines of treatment (LOT) received was 2 (IQR 1-3), with 39% of patients having received >2 LOT. Among patients with lung complications (n = 24), 41% had received 3 or more LOT. Among patients with scleroderma (n = 22), 77% had received 3 or more LOT, 23% of which had received 6 or more unique treatments.
Conclusions:
The first treatment given to cGVHD patients was corticosteroids. Ruxolitinib was the most used second-line treatment. About 40% of cGVHD patients received >2 treatments, and scleroderma was associated with more LOT. There is a need for more effective cGVHD treatment options when early treatments fail to resolve complications.
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