Corey S. Cutler, MD, MPH, FRCPC

Case Overview: 49-Year-Old Man With Chronic GvHD

Definition of GvHD

Treatment Options for Chronic GvHD

Steroid-Refractory GvHD: Treatment With JAK Inhibitors

Emerging Agents for the Treatment of Chronic GvHD

Future Directions and Unmet Needs in Chronic GvHD

Case: A 49-Year-Old Man With Steroid-Refractory Chronic Graft Versus Host Disease

A 49-year-old man complains of “color and texture” changes to his skin, nails and the inside of his mouth; he also complains of shoulder and elbow joint discomfort limiting his normal daily activity

PMH: he underwent matched related allogenic transplant from his brother for treatment of AML

PE: depigmentation and lichen planus-like features noted on his chin, nose, cheeks and forearms bilaterally, and in the oral mucosa (~40% BSA); longitudinal ridging of the fingernails; joint stiffness and decreased range of motion



Labs: plt 70 x 109/L, total bilirubin 7.6 mg/dl, AST 150 U/L, ALT 165 U/L, ALP 430 U/L

NIH Global Severity of cGvHD moderate cGvHD; P-ROM score 4

He was started on ruxolitinib 5 mg PO BID which was tolerated well; increased to 10 mg PO BID on day 6

Videos

Corey S. Cutler, MD, MPH, FRCPC, provides insight on the case of a 49-year-old man with chronic GVHD and reviews current and emerging treatment options for disease management.

A 49-Year-Old Man With Steroid-Refractory Chronic Graft Versus Host Disease

Corey S. Cutler, MD, MPH, medical director of the Stem Cell Transplant Program, Dana-Farber Cancer Institute, discusses the current treatment options for patients with chronic graft-versus-host-disease (GVHD) and highlighted some upcoming research.

Corticosteroids remains the mainstay of therapy in chronic GVHD, says Cutler. However, 50% to 60% of patients who receive steroids will become refractory within the first year of therapy, so there is another FDA-approved treatment available, which is the BTK inhibitor Ibrutinib (Imbruvica). This agent, which is approved for patients with steroid-refractory chronic GVHD, demonstrated a relatively impressive response rate around 60% in a small open-label phase II clinical trial.

Beyond ibrutinib, Cutler says there is no approved third-line option for patients with chronic GVHD. The most promising agent, however, is KD025, a ROCK2 inhibitor. He expects to hear more about this agent in the coming years, but a recent randomized phase II trial showed responses in approximately 65% of heavily pretreated patients. Cutler says experts anxiously await the final results of this study, and hopefully there will be an FDA approval to follow as well.

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Corey S. Cutler, MD, MPH, discusses the current treatment options for patients with chronic graft-versus-host-disease and highlighted some upcoming research.

Corey S. Cutler, MD, MPH, FRCPC | Authors

Articles

A 49-Year-Old Man With Steroid-Refractory Chronic Graft Versus Host Disease

Steroid-Refractory Chronic GVHD Requires More Treatment Options