The panelists share their insights on the identification of patients at high risk for GVHD.
Yi-Bin Chen, MD: We talked about risk factors for GVHD [graft versus host disease] in general. Let’s talk a bit about, after the patient has received a transplant, all things being equal, are there things you look for besides what Catherine talked about, being getting acute GVHD? Are there other things you look for that it stick in your mind as being at high risk for chronic graft versus host disease going forward? I’ll open that up if anybody wants to take a stab.
Corey S. Cutler, MD, MPH, FRCPC: I wish we had biomarkers that could help predict. I think there are some interesting potential biomarkers out there. David Miklos, [MD,] has proposed looking at the emergence of specific antibodies against Y-encoded coated antigens in a subset of patients. Sophie Paczesny, [MD, PhD,] has her own panel of biomarkers using proteomics. And Kirk Schultz, [MD,] in Vancouver has yet another set of biomarkers that are potentially useful, but I don’t think there are any great mainstream ways that we can identify these patients early. I think we all see signs or symptoms that are suggestive of the early emergence of chronic GVHD that don’t quite make the clinical criteria, which I’m sure we’ll review later. But there’s really nothing good on a clinical basis to predict.
Yi-Bin Chen, MD: The need for predictive biomarkers, not only to [predict who will] develop the disease, but more as we’ll talk about, to predict for response to treatment is a huge unmet need in what we do. But it would be great. I think we’d all agree it would be great if we could send off a panel on our patients, and that would give us some sort of metric or measure of the alloimmunity that’s ongoing in our patients. It would also open the door to be able to do certain preemptive clinical trials to prevent chronic graft versus host disease. But I think it’s tough. There are companies and also our colleagues have led discussions about how do we do trials to specifically prevent chronic graft versus hosts disease as we’re taking care of the patient. But to do that, it’s helpful if you’re able to identify a group of patients at high risk. And so, this is a huge need for us, going forward.
Catherine J. Lee, MD, MS: I just want to add that I agree that laboratory biomarkers are probably going to be very important here. But as you said, there are colleagues who are looking at machine learning and AI [artificial intelligence] to test a variety of clinical variables to predict who will develop chronic GVHD. And as well, I know that a few of our colleagues are working on a CIBMTR [Center for International Blood & Marrow Transplant Research] registry study using large data sets to develop an algorithm to determine who, based on clinical variables, will develop chronic GVHD requiring systemic immunosuppression.
Yi-Bin Chen, MD: Using those modern tools is definitely really interesting.
Transcript edited for clarity.