Individualizing Treatment Selection in Steroid-Refractory Chronic GVHD

This segment brings the approved therapies side by side and asks what actually drives treatment selection. Faculty agree there is rarely a single deciding factor, weighing organ involvement, prior exposure, route and frequency of administration, comorbidities, and access together. A key caution emerges: because pivotal trials did not restrict agents to specific manifestations, choosing a drug on organ involvement alone is not well supported by evidence. Instead, faculty describe individualizing therapy around the patient in front of them, often leading with a toxicity-first philosophy, asking not only which drug a patient is most likely to respond to, but which they are least likely to tolerate. Access and patient preference frequently become the determining factors, since a therapy only helps if the patient can reliably receive it. The discussion also reframes goals of therapy, emphasizing that in refractory disease a durable partial response supporting daily function can be as clinically meaningful as complete response.