Future Perspectives in cGVHD
Panelists discuss how future directions in chronic graft-vs-host disease (cGVHD) management may include preemptive use of targeted therapies, first-line treatment with newer agents, and cell-based approaches.
Future Directions
For therapy sequencing, approaches varied:
- Dr Shaughnessy: Generally switching between agents with brief steroid pulse
- Dr Bishop: Adding new agents to maintain control from multiple mechanisms
- Dr Lee: Cautious about combining without safety data, preferring switching
Future directions the panel is excited about:
- Moving targeted agents to first-line therapy
- Cell therapies for cGVHD (mesenchymal stromal cells as precedent from pediatric acute GVHD)
- Combination therapies in single molecules (eg, ROCK/JAK inhibitor)
- Agents targeting cell migration
Key principles for treatment goals:
- Symptom control and quality of life improvement
- Getting patients off steroids
- Disease stabilization, especially for lung involvement
- Tailoring therapy to organ involvement and tolerability
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