Navigating treatment sequencing of cGvHD: Real-world insights

Chronic graft-versus-host disease (cGvHD) can present with complications of variable severity affecting the skin, fascia, liver, gastrointestinal tract, eyes, mouth, and lungs.¹ Corticosteroids are the standard first-line treatment to treat these complications; however, subsequent treatment options after first-line therapy are unclear, due to high levels of uncontrolled immune response and treatment-induced toxicities.¹

Here, we summarize key data regarding real-world treatment sequencing at Canadian transplant centers, published by Kim et al.¹ in Transplantation Proceedings.

Study design¹

• A retrospective study of adult patients with cGvHD who received allogeneic hematopoietic stem cell transplantation greater than 18 months before data collection, from seven Canadian transplant centers, between September–November 2022.
• Data variables included patient characteristics, cGvHD complications information and management, and physician-reported healthcare resource utilization.
• Median values and interquartile ranges (IQR) were presented if data was not normally distributed.

Key findings¹

• In total, 77 patients with a median age of 52 were included in this study.
• Overall, 99% of patients received prednisone at some point during cGvHD treatment, as shown in Table 1. The median current dose was 27.5 mg/day (IQR, 8.5–35.0).

Table 1. Treatment received by patients with GvHD*

• First-line treatment of prednisone was paired with calcineurin inhibitors. 28% of patients received the cyclosporine combination and 16% received the tacrolimus combination.
• Ruxolitinib was the most common second-line therapy (37%), followed by mycophenolate mofetil/mycophenolic acid (17%).
• Among patients still on active systemic therapy (n = 59), prednisone and ruxolitinib were equally common at 47%.
• The most common third-line therapy was ruxolitinib (47%), again followed by mycophenolate mofetil/mycophenolic acid (17%).
• Overall, 80% of patients with cGvHD received ≤3 lines of therapy, and patients received ≥3 lines of therapy when lung complications (41%) or scleroderma (77%) were involved (Figure 1).

Figure 1. Lines of therapy received by patients with cGvHD and those with lung involvement or scleroderma* 

cGvHD, chronic graft-versus-host disease.
*Adapted from Dennis, et al.¹

• During the management of serious complications, follow-up appointments were required more frequently than in the absence of serious complications, 14 days (IQR 7–16) and 61 days (IQR 28–84), respectively.