The Current Field of Graft Versus Host Disease - Episode 6

Additional Therapy Options for Steroid-Refractory cGVHD

Robert Zeiser, MD, touches on additional therapeutic options for steroid-refractory chronic graft-vs-host-disease, such as extracorporeal photopheresis, mycophenolate, everolimus, and more.

Robert Zeiser, MD: Besides ruxolitinib, ibrutinib, and belumosudil, there are several other commonly used treatment options for …chronic graft-vs-host-disease [cGVHD], those include for example extracorporeal photopheresis. For this intervention, called ECP, the presence of a venous access catheter is required. This treatment has a good safety profile and it was shown that it reduces the use of corticosteroids. Patients with cGVHD that have had steroids can also receive calcineurin inhibitors [CNIs]. It was shown that CNIs reduce the use of corticosteroids and the adverse effects are, in particular, renal impairment and hypertension. In patients failing corticosteroids, we can also use mTOR inhibitors, such as sirolimus or everolimus, and they are sometimes combined with CNI inhibitors which increase the risk of endocellular damage so called TMA [thrombotic microangiopathy]. They can lead to thrombocytopenia and they interfere with wound healing. MMF [mycophenolate mofetil] was also shown to reduce the use of corticosteroids but it increases the risk of reactivation and relapse. In itself, MMF can induce colitis which can mimic cGVHD of the GI [gastrointestinal] tract.

Transcript edited for clarity.