In chronic GvHD, it’s kind of the same theme that follows. I think the field has moved towards more broad administration of immune suppression to more targeted, I would say, immunomodulation. So on one side you have a GvHD prophylaxis and here really PTCy has been a paradigm shift and is now being used in essentially all kinds of transplants that we do. And then you have abatacept that is particularly important for unrelated donor transplant...
In chronic GvHD, it’s kind of the same theme that follows. I think the field has moved towards more broad administration of immune suppression to more targeted, I would say, immunomodulation. So on one side you have a GvHD prophylaxis and here really PTCy has been a paradigm shift and is now being used in essentially all kinds of transplants that we do. And then you have abatacept that is particularly important for unrelated donor transplant. And I think here the question will be how to fine tune the dosing. Can we combine these two agents or sequence them? So there has been a lot of studies coming up in the field of prophylaxis. And then as a treatment for acute GvHD, we have a ROCK inhibition with ruxolitinib that is approved for steroid refractory acute GvHD. But here, the interesting studies are now bringing ruxolitinib earlier in the treatment for newly diagnosed acute GvHD. And there have been quite a few studies, but I want to kind of single out work from the MAGIC consortium where you use really biomarkers to kind of decide. And there’s a multi-center study going on where people can get only ruxolitinib if they are kind of low-risk or ruxolitinib with steroids for high-risk acute GvHD. So I think this will be one important study that will go forward. And the other study that has just opened and started enrolling is a study through BMT-CTN for steroid refractory where you combine ruxolitinib and it’s a randomized study. So everybody gets ruxolitinib and then people are randomized to get mesenchymal stem cells versus placebo to see whether that can improve the response in steroid refractory acute GvHD as a second line. So these are kind of some new studies in that field. And then for chronic GvHD, you know, we have all these different drugs that are having different mechanisms of action, ROCK inhibition with belumosudil, JAK inhibition, anacrophages with axatilimab and then BTK inhibition with ibrutinib. And the question and studies here are really to help us learn how to, can we combine these drugs and how to combine them, how to sequence them and really which drug works best for different phenotypes of chronic GvHD.
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