EBMT 2018 | Chronic GvHD therapy

Daniel Wolff

Speaking from the 2018 European Society for Blood and Marrow Transplantation (EBMT) Annual Meeting in Lisbon, Portugal, Daniel Wolff, MD, PhD, of the University Hospital of Regensburg, Regensburg, Germany, talks about the developments that have been made in treating chronic GvHD and highlights areas for future progress.

Transcript (edited for clarity):

The session was just on chronic graft versus host disease, with the first talk provided by Stephen Pavletic from the NIH on staging and diagnosis, the second part on first line treatment provided by myself and Attilio Oliveira at the end provided to talk on second line treatment of chronic graft versus host disease.

The first talk was on the development and the application of the newer NIH criteria on chronic graft versus host disease and the effect this new proposed criteria had where we’re now in the position, thanks to standardized criteria that we have the first drug approved for treatment of chronic graft versus host disease. And we have a lot of trials recruiting, including trials which would cover first-line treatment of chronic graft versus host disease.

My talk was on first line treatment which summarized the, basically the don’t knows of the of the field because we randomized trials on chronic graft versus host disease where I were from the 80’s, so meaning from a time where practice pattern were quite different than today or it didn’t ask the question what would be the standard treatment for first-line treatment. So this will hopefully change through the next two years because two trials recruit or stop recruiting of evaluating first-line treatment, and hopefully this will change to their practice.

This the last job by Attilio Olivieri was on second line treatment of chronic graft versus host disease summarizing the increasing number of agents available with different biological mechanisms. He nicely showed that we urgently need randomised trials and control trials, as an recent review revealed that more stringent the criteria are you apply will lower your response rate you get, meaning that small phase two trials or even retrospective analyzes overestimate the effect of the treatment which then is not fitting with the perception in clinical care. He also nicely showed two cases where we discussed the current problems we faced with patients requiring different treatment lines until resolution is chronic versus host disease is achieved.

Finally, if after the first actual we talked about the future of chronic graft versus host disease and still Pavletic just pointed out that he hopes that in ten years we will be able to characterize chronic graft versus host disease much more based on biology than just clinical criteria which will then lead to a tailored treatment.

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