Belumosudil and the Evolving Role of Ibrutinib in Chronic GVHD

This segment examines where belumosudil fits in the steroid-refractory treatment landscape and why ibrutinib has largely receded from practice. Faculty review the ROCKSTAR findings that established belumosudil for patients who have failed prior lines of therapy, highlighting the overall response rate, durable responses, steroid reduction, and activity across a broad range of organ systems, including the fibrotic and sclerotic manifestations that have historically been difficult to treat. The panel emphasizes its favorable tolerability, oral convenience for patients facing long treatment durations, and real-world performance consistent with the trial. Sequencing is discussed, with belumosudil positioned for patients with sclerotic features or those needing an alternative to ruxolitinib. Attention then shifts to ibrutinib, whose use has become limited given its small, inflammatory-only trial population, disappointing real-world durability, and tolerability concerns in older patients. A panel poll confirms none continue to reach for it, reflecting how the expanding armamentarium has reshaped practice.