Post-Conference Perspectives: Advances in Chronic and Acute Graft-versus-Host Disease - Episode 1

Treatment Landscape of Graft-Versus-Host Disease


Yi-Bin A. Chen, MD: Graft-versus-host disease (GVHD) remains a major complication for patients after allogeneic hematopoietic stem cell transplantation. Acute graft-versus-host disease is the leading cause of transplant-related mortality in the first few months after transplant. And chronic graft-versus-host disease is the single biggest determinant of long-term quality of life in those patients who are long-term survivors.

It is true over the past couple of decades that the severity of graft-versus host disease has decreased, and this has been due to several factors, both in transplant and in medicine. We certainly improved in how we type donors and recipients for better matches. We choose our patients better. We most likely give less intense conditioning to our patients prior to transplant. And we treat complications better, such as various infections and other complications that have allowed patients to survive in the posttransplant setting.

Nevertheless, treatment of graft-versus-host disease remains a major challenge for us in the transplant community. The traditional approach has always been systemic immunosuppression based around systemic corticosteroids and other agents. The reason for this, is because we believe that graft-versus- host disease, the underpinning of GVHD, was donor cells attacking normal host tissue. And intuitively it made sense then to try and suppress donor cells. The drawback to such therapies included broad immunosuppression and put our patients at risk for opportunistic infection, and possibly damaged the overall healthful graph versus malignancy affect.

As we move forward, we’ve started to realize that perhaps broad immunosuppression is not the answer for graft-versus-host disease, and newer therapies will hopefully show us that this is true.