Systemic Therapies for Steroid-Refractory cGVHD: Second Line and Beyond

Case Progression and Treatment Selection

This segment returns to the clinical case of a 50-year-old woman with chronic GVHD who, after initial improvement on ruxolitinib and steroids, experiences progression with worsening pulmonary symptoms, new sclerotic skin changes, and liver abnormalities.

The panel discusses factors influencing post–ruxolitinib therapy selection. There is consensus that belumosudil would be appropriate given its:

• Antifibrotic mechanism potentially beneficial for lung involvement
• Data supporting efficacy in bronchiolitis obliterans
• Generally good tolerability with minimal liver issues

The panel also discusses cytopenia management in chronic GVHD, noting that while ruxolitinib may contribute to cytopenias, sometimes the underlying disease is causing bone marrow fibrosis that may respond to treatment.