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Updates in chronic graft-versus-host disease: novel treatments and best practices in the current era

Bone Marrow Transplantation volume 59, pages 1360–1368 (2024)Cite this article

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Abstract

Chronic graft-versus-host disease (cGVHD) is a serious complication of allogeneic hematopoietic cell transplant. The development of cGVHD involves a complex, multistep process that is characterized by early inflammation and tissue injury, followed by chronic inflammation, aberrant tissue repair, and fibrosis. Systemic corticosteroids remain the first line of treatment for cGVHD. New treatments for patients with cGVHD for whom treatment has failed or who develop steroid-dependent cGVHD are now available; these include ibrutinib, ruxolitinib, and belumosudil. Treatment selection may be based on the patient’s individual needs, graft-versus-host disease organ involvement, and comorbidities. However, as therapeutic options for patients without a treatment response or with only a partial response remain an unmet need, new agents are under investigation. Furthermore, patients with cGVHD can develop multiorgan involvement and frequently require specialized care. A multidisciplinary team approach that focuses on the individual’s needs and quality of life is strongly encouraged.

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Fig. 1: Pathophysiology of chronic graft-versus-host disease.
Fig. 2: Mechanism of action of ibrutinib, ruxolitinib, and belumosudil in chronic graft-versus-host disease.

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Acknowledgements

This work was supported, in part, by the National Institutes of Health (P01 CA23766 [to Memorial Sloan Kettering Cancer Center], P30 CA008748 [to Memorial Sloan Kettering Cancer Center], and R01 HL164902 [to DMP]). Editorial support in the preparation of this manuscript was provided by David B. Sewell, MA, MFA, of the Memorial Sloan Kettering Cancer Center, Department of Surgery. Graphic support was provided by ICON PLC and funded by Incyte under the authors’ guidance.

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Author notes

  1. These authors contributed equally: Grashma Vadakkel, Stephen Eng.

  2. These authors jointly supervised this work: Anthony Proli, Doris M. Ponce.

Authors and Affiliations

  1. Department of Pharmacy, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Grashma Vadakkel & Stephen Eng

  2. Flatiron Health Inc, New York, NY, USA

    Anthony Proli

  3. Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Doris M. Ponce

  4. Weill Cornell Medical College, New York, NY, USA

    Doris M. Ponce

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GV, SE, AP, and DMP designed the project, identified and analyzed the literature, wrote and revised the manuscript.

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Correspondence to Grashma Vadakkel or Doris M. Ponce.

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Competing interests

SE has received speaking honorarium from Incyte. DMP has served as an advisory board member for Evive Biotechnology (Shanghai; formerly Generon [Shanghai]), as an advisory board member or consultant for Sanofi, CareDx, Ceramedix, and Incyte, and receives research funding from Incyte and Sanofi. AP is a current employee of Flatiron Health and a current equity holder in Roche. The other authors have no conflicts of interest to declare. Graphic support was provided by ICON PLC and funded by Incyte under the authors’ guidance.

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Vadakkel, G., Eng, S., Proli, A. et al. Updates in chronic graft-versus-host disease: novel treatments and best practices in the current era. Bone Marrow Transplant 59, 1360–1368 (2024). https://doi.org/10.1038/s41409-024-02370-8

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