The Current State of Chronic GVHD Management

This opening segment sets the stage for how refractory chronic graft-versus-host disease is managed today. The panel describes a field that has moved beyond a steroid-only mindset, now drawing on several mechanistically distinct targeted therapies, including ruxolitinib, belumosudil, and axatilimab. Faculty discuss how treatment goals have evolved: rather than symptom control alone, the emphasis has shifted toward minimizing steroid exposure, preserving organ function, supporting immune recovery, and achieving durable, long-term disease control. The conversation turns to treatment selection once patients progress through first- and second-line therapy, with faculty weighing organ-system involvement, the manifestations causing the most pressing symptoms, prior therapy exposure, and cumulative toxicity. Logistics emerge as a central theme, as clinicians consider whether a patient can tolerate infusion-based treatment or is better suited to oral therapy. The segment frames chronic GVHD care as increasingly individualized, biologically informed, and tailored to each patient's history.