Chronic graft-versus-host disease: newer treatment strategies

It has been shown that the pathobiology of chronic graft-versus-host disease (cGvHD) involves a complex interplay between the immune systems of the donor and the recipient. Donor-derived T cells play a major role in cGvHD as the preeminent mediators, however, aberrant B cells also contribute to the pathogenesis of cGvHD by increasing inflammation and autoimmunity, as well as vulnerability to severe infections. Corticosteroids are the accepted first-line therapy, with or without other immunosuppressive agents for the treatment of cGvHD. If a patient is refractory to steroids or has progressive disease, second-line treatment is required. Despite significant progress in the development of effective second-line treatments for steroid-refractory cGvHD, the response rate to second-line therapy is approximately 25–50%, with no significant differences between therapy options. Ibrutinib is currently approved in the US for the treatment of cGvHD after failure of one or more lines of systemic therapy, however, there is an unmet need in the development of novel treatment strategies to improve post-transplant outcomes. Please see the current novel therapy options in the downloadable table below: