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3 weeks ago | 
targetedonc.com | Catherine Lee |Michael Bishop |Paul Shaughnessy
June 2, 2025By Panelists discuss how clinicians typically taper steroids slowly after starting second-line agents for chronic graft-vs-host disease (cGVHD). Steroid Tapering with Second-Line TherapyThis detailed segment covers approaches to steroid tapering when initiating second-line therapy.
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3 weeks ago | 
targetedonc.com | Catherine Lee |Michael Bishop |Paul Shaughnessy
June 2, 2025By Panelists discuss how belumosudil is particularly effective for patients with lung involvement due to its antifibrotic mechanism. Case Progression and Treatment SelectionThis segment returns to the clinical case of a 50-year-old woman with chronic GVHD who, after initial improvement on ruxolitinib and steroids, experiences progression with worsening pulmonary symptoms, new sclerotic skin changes, and liver abnormalities.
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1 month ago | 
targetedonc.com | Catherine Lee |Michael Bishop |Paul Shaughnessy
May 26, 2025 By Panelists discuss how most clinicians prefer ruxolitinib over ibrutinib as second-line therapy due to better tolerability Ruxolitinib Data and Clinical Experience This segment focuses on the REACH-3 study data for ruxolitinib, demonstrating significant advantages over best available therapy: Median failure-free survival: 38 months vs 6 months 12-month failure-free survival probability: 64% vs 30% Duration of response was not reached in the ruxolitinib group vs 6.5 months in...
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1 month ago | 
targetedonc.com | Catherine Lee |Michael Bishop |Paul Shaughnessy
May 26, 2025By Panelists discuss how FDA-approved therapies such as ibrutinib, ruxolitinib, belumosudil, and axatilimab provide treatment options for steroid-refractory chronic graft-vs-host disease (cGVHD).
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1 month ago | 
targetedonc.com | Catherine Lee |Michael Bishop |Paul Shaughnessy
Steroid Management and ProphylaxisThis segment focuses on steroid management and prophylaxis in chronic GVHD patients. The panel discusses steroid tapering approaches (typically 10-mg reductions every 4 weeks, slowing at 20 mg daily) and addressing steroid complications.
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1 month ago | 
targetedonc.com | Catherine Lee |Michael Bishop |Paul Shaughnessy
Clinical Case Continued (Part 2)In the clinical case, prednisone at 0.5 mg/kg/day was initiated with a 6-week taper. The patient initially improved but experienced progression during tapering. Steroids were increased again, but another taper was unsuccessful, leading to diagnosis of steroid-refractory cGVHD.
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1 month ago | 
targetedonc.com | Catherine Lee |Michael Bishop |Paul Shaughnessy
Treatment Approaches (Part 1) For newly diagnosed moderate to severe cGVHD, the panel discussed: Initial steroid dosing: Dr Bishop: 1 mg/kg/day for severe cases, possibly split dosing Dr Shaughnessy: 0.5 mg/kg/day for many cases, 1 mg/kg/day for severe lung or liver involvement All agree on assessing response for at least 1-2 weeks before tapering Steroid taper considerations: Slow, cautious tapers, especially for cGVHD (unlike acute GVHD) Generally 10 mg every 1-2 weeks after stabilization,...
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1 month ago | 
targetedonc.com | Catherine Lee |Michael Bishop |Paul Shaughnessy
Clinical Case Presentation (Part 1)A 50-year-old woman underwent allogeneic transplant with reduced-intensity conditioning from a matched unrelated donor for mesenchymal stromal cells. Her donor was a cytomegalovirus-negative 45-year-old man, and GVHD prophylaxis was tacrolimus and mycophenolate mofetil.
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1 month ago | 
targetedonc.com | Catherine Lee |Michael Bishop |Paul Shaughnessy
Difficult-to-Diagnose Manifestations The panelists discussed challenging presentations: Pulmonary involvement is often insidious, requiring careful monitoring with serial PFTs Genital/gynecologic involvement is often underdiagnosed but impacts quality of life significantly Neuropathies are difficult to attribute to cGVHD due to multiple potential causes Peripheral edema can make assessment of skin thickening/sclerosis challenging Serositis (inflammation of tissue lining around heart, lungs,...
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1 month ago | 
targetedonc.com | Catherine Lee |Michael Bishop |Paul Shaughnessy
Diagnosis and Clinical ChallengesFor diagnosis, the panel generally relies on clinical features rather than biopsies for typical presentations.
