Hildegard Greinix, MD, Medical University of Graz, Graz, Austria, gives an overview of her presentation on recent advances in the management of chronic graft-versus-host disease (cGvHD). Treatments leading to long-term improvements for patients with cGvHD present an unmet clinical need. The prospective Phase III REACH3 study (NCT03112603) is evaluating the efficacy of ruxolitinib versus best available therapy (BAT) as a second-line treatment for patients with steroid-refractory cGvHD (SR-cGvHD) or steroid-dependent cGvHD (SD-cGvHD). Prof. Greinix reports that this study has demonstrated a significantly improved efficacy for patients receiving ruxolitinib in terms of overall response rates (ORR) and non-relapse mortality (NRM). An older study investigating conventional therapy alone (corticosteroids with/without calcineurin inhibitors and with/without mycophenolate mofetil (MMF)) versus conventional therapy in combination with extracorporeal photopheresis (ECP) in patients with SR- and SD-cGvHD reported that complete response rates (CRR) were significantly higher in the ECP arm. Prof. Greinix explains that despite the positive results of the REACH3 trial, several challenges remain for ruxolitinib to become standard of care for second-line treatment of cGvHD. Indeed, ruxolitinib has not yet been approved by the EMA, is very expensive and induces severe side effects. Finally, it is important to note that patients with eye, liver and lung involvement had low response rates to ruxolitinib. A longer follow-up is thus required to confirm the durability of responses to ruxolitinib and to investigate late toxicities. This interview took place at the 6th Congress on Controversies in Stem Cell Transplantation and Cellular Therapies (COSTEM), which took place virtually.
