GvHD Hub

During the GvHD Hub Steering Committee meeting in November 2022, key opinion leaders met to discuss what supportive care should look like for patients with chronic graft-versus-host disease (GvHD). The recorded discussion was chaired by Professor Amin Alousi (University of Texas MD Anderson Cancer Centre, Houston, US) and featured Mutlu Arat (Istanbul Florence Nightingale Hospital, Istanbul, TR), Ali Bazarbachi (American University of Beirut, Beirut, LB), Hildegard Greinix (Medical University of Graz, Graz, AT), and Attilio Olivieri (Ospedali Riuniti di Ancona, Ancona, IT).

Professor Alousi opens by highlighting the importance of supportive care in GvHD and the challenges in ensuring this is delivered effectively. This discussion focusses on the side effects and adverse events associated with GvHD treatments, including those that may have a negative impact on a patient’s quality of life.

The steering committee members discuss the need for a multidisciplinary approach to GvHD treatment through communication with other healthcare professionals (HCPs). For example, mental health professionals, pharmacists, and ophthalmologists may all be involved in the treatment of a patient with GvHD depending on the manifestation of the disease. The discussion concludes that cross-functional collaboration of HCPs may have a positive impact on quality of life and requires further research.

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During the 2022 Transplantation & Cellular Therapy Meetings of ASTCT and CIBMTR (Tandem Meetings), the GvHD Hub was pleased to speak to Gérard Socié, Hôpital Saint-Louis, Paris, FR. We asked, How would you treat acute GvHD (aGvHD) in your clinic (an EU perspective)?

Socié begins by highlighting the main differences between aGvHD treatment in the EU and in the US. Socié then discusses the use of steroids in aGvHD treatment, despite 40–50% of patients becoming steroid-resistant. Finally, Socié talks about the current standard of care in steroid-resistant aGvHD.

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During the 48th Annual Meeting of the European Society for Blood and Marrow Transplantation (EBMT), the GvHD Hub was pleased to speak to Zinaida Perić, University of Zagreb, Zagreb, HR, and Bipin Savani, Vanderbilt University Medical Center, Nashville, US. We asked, What should supportive care look like for patients with GvHD? What role does physical activity play in these patients? 

Savani begins by highlighting the importance of supportive care for patients with GvHD. Perić then discusses how, if local therapy is effective enough, systemic treatment can be avoided, and how there should always be an aim to use the least immunosuppression possible. Savani goes on to talk about pain and fatigue management in these patients and how physical therapy could play a role. Finally, both Perić and Savani emphasize that supportive care should be a priority, and more data on the use of physical exercise and therapy is key to improving the quality of life for patients with GvHD.

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During the 48th Annual Meeting of the European Society for Blood and Marrow Transplantation (EBMT), the GvHD Hub was pleased to speak to Daniel Weisdorf, University of Minnesota, Minneapolis, US. We asked, How do we stratify risk in patients with GvHD? 

Weisdorf begins by discussing the Minnesota Risk Score (M. MacMillan, et al.), which uses the stage of skin, liver, and gut involvement in GvHD to predict the response to therapy. Weisdorf then talks about the potential of incorporating biomarkers into the Minnesota Risk Score in the future.

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During the 63rd ASH Annual Meeting and Exposition, the GvHD Hub was pleased to speak to steering committee member Mohamad Mohty, Hôpital Saint-Antoine, Paris, FR. We asked, What's the latest in treatment of steroid-refractory acute GvHD at ASH 2021?

In this podcast, Mohty highlights the latest advances in the field of steroid-refractory acute GvHD and emphasizes the importance of prevention, commenting on anti-thymocyte globulin (ATG), allogeneic hematopoietic stem cell transplant (allo-HSCT), and posttransplant cyclophosphamide. Mohty also mentions the HERACLES trial (NCT03225937) and the use of the JAK inhibitor ruxolitinib. 

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During the 47th Annual Meeting of the European Society for Blood and Marrow Transplantation (EBMT), the GvHD Hub spoke to Nada Hamad, St Vincent's Hospital Sydney, Sydney, AU, and Silvy Lachance, Hôpital Maisonneuve-Rosemont, Montreal, CA. We asked, How can patient-reported QoL change our view on unmet needs in GvHD?

The main topic of this podcast is about documenting the quality of life (QoL) of patients with acute and chronic GvHD. Lachance focuses on patient-reported outcomes regarding the impact GvHD has on aspects of daily life. Research has demonstrated that GvHD severity, long term corticoid treatment, or being corticoid resistant have a significant impact on QoL.

Hamad continues the conversation by exploring the stress of survival for patients undergoing bone marrow transplantation. She believes that patient self-reported symptoms should direct future research on GvHD treatment and prevention. 

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During the American Association of Cancer Research (AACR) Virtual Annual Meeting I, the GvHD Hub was pleased to speak to Christine Spencer, Parker Institute for Cancer Immunotherapy, San-Francisco, US and Diwakar Davar, University of Pennsylvania Medical Center, Pittsburgh, US. We asked: how can we use the microbiome to improve cancer immunotherapy and alleviate side effects such as graft-versus-host-disease?

In this podcast, Dr Davar starts by providing a background on the importance of the microbiome in adaptive and innate immunity, while Dr Spencer states the importance of the cross-talk between the microbiome and immune system through microbial products, peptides, and metabolites. Dr Davar then explains the concept of immunosurveillance, immunoediting, and checkpoint inhibitors. Dr Spencer describes fecal microbiome transplant studies that showed features of the microbiome can predict response to immunotherapy and effect T-cell expression. Dr Davar then describes some of the studies that are looking at fecal microbiome transplant in combination with checkpoint inhibitors. He goes on to discuss studies investigating the use of live bacterial products to elicit the same effects as fecal microbiome transplant, particularly the mediation of CD8 T cells. Dr Spencer also talks about probiotics, antibiotics, and diet and explains how this can affect the gut microbiome and describes studies looking at these features in terms of response to immunotherapies. She also describes the microbiome research related to graft-versus-host-disease and the impact of higher alpha diversity on post-transplant survival, while Dr Davar explains how the microbiome may also affect toxicity and side-effects of cancer immunotherapies. 

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