Gergis Explains the Differences Between Acute and Chronic GVHD – Targeted Oncology
Posted: February 17, 2021 at 1:50 am
Usama Gergis, MD, MBA Professor of Oncology Director, Bone Marrow Transplant and Immune Cellular Therapy Sidney Kimmel Cancer Center Thomas Jefferson University Hospital Philadelphia, PA, reviewed that difference in acute and chronic graft-versus-host disease (GVHD) and the treatment available for each.
Targeted OncologyTM: How would you treat a patient with GvHD in the second line?
GERGIS: If you [have a patient with] second-line acute GVHD, your answer should be ruxolitinib [Jakafi] because its the only drug that has been tried in phase 3 trials. If you get a [case of] chronic GVHD, your answer should be ibrutinib [Imbruvica].
What is the efficacy of peripheral blood stem cells (PBSC) versus bone marrow from unrelated donors in patients with acute and chronic GvHD?
[Results from] a phase 3 study of bone marrow versus stem cells for unrelated donors [showed] the acute GVHD population [cumulative incidence] was the same between both.1 For the chronic population, the bone marrow did better [PBSC 53% vs bone marrow 41%; P = .01]. This was published almost 8 years ago, [and it] was reported almost 10 years ago, but we still use stem cells.
This has not changed practices, and the reasons are, number 1, there was more primary graft failure on the bone marrow than the PBSC, and number 2, its pretty involved to do bone marrow harvest, although I have done it for 15 years, at least a few every month.
The benefit of bone marrow versus PBSCand this benefit was only studied in unrelated donors, not in matched related donorswas seen across all organs affected with chronic GVHD except lungs, [gut, and serosa].2 So, there was no real benefit in the lungs.
Can you explain the difference between acute and chronic GvHD?
Chronic GVHD is more complicated and involved than acute GVHD. In acute, you have the skin, gastrointestinal organs, and the liver [that may be affected]. Thats it. In chronic, all the patients other organs can be affected. The patients weight can be affected. [Chronic GVHD is] more debilitating over a long time and [can] go unrecognized for a while. [If a patient is] experiencing acute GVHD, you see them twice a week, whereas if the patient has chronic GVHD, you probably see them once a month. So you can see a very stark change in your patients within that month if they lose 10% of their body weight and they already lost a lot of weight in the period right after [transplantation], so that can be obvious to you.
[In my institution], we have the GVHD clinic where we [grade the patient based on] studying the degree of fibrosis, how many organs are affected, the patients range of motion, and the degrees in range of motion. We do frequent pulmonary function tests and various [other] testing. By looking at all the affected organs, you reach a grade, and that can be mild, moderate, or severe [chronic GVHD].
How do you treat moderate-to-severe chronic GVHD at initial presentation and in the second line?
First-line treatment for chronic GVHD are steroids. For second line, there are many agents [to consider]. Ive tried most of them. I like photopheresis because its not pharmacological, but its pretty involved. Your patient will need a permanent catheter, and they will need to come to the transplant center twice a week, and you see a response after a long time. It takes an average of 50 photopheresis sessions for a response. But the beauty of photopheresis [is that] you could try it with other agents, so its not mutually exclusive. You could use it with ruxolitinib, ibrutinib, or any other agents.
The answer will be ibrutinib [for chronic GVHD], and thats based on the [results of a] phase 2 clinical trial that treated 42 patients with steroid-refractory chronic GVHD, and the efficacy was 69% [best overall response rate], and 31% complete response rate.3
What do you think of these poll results?
Everybody agrees on giving ibrutinib. When I gave this talk a couple months ago, lenalidomide [Revlimid] was not included in the poll. I added it because [recently], a nice study in Blood came out from the National Institutes of Health where they tried lenalidomide at a small dose, 2 mg, in steroid-refractory chronic GVHD. Its a large trial; I think its about 100 patients. Theyve seen responses that are comparable with ibrutinib....I treated a patient for multiple myeloma; he received a transplant for multiple myeloma, and now, 6 months later, he has chronic GVHD and some clonal plasma cells. So for him, I was comforted to know the results of the lenalidomide trial.
How does ruxolitinib play a role in this setting?
Ruxolitinib was reported in the REACH3 trial [NCT03112603] with very good responses in chronic GVHD.4 I think it probably will get approved for that indication. Looking at this study about 2 years ago, nothing was studied well in this indication, and ibrutinib was approved.
REACH3 was a large trial, almost 300 patients, and everybody was randomized to ruxolitinib 10 mg twice a day versus best available treatment. They looked at everybody about 6 months later for response.
What should physicians keep in mind when treating?
Chronic GvHD is pretty involved. Your patients will need a multidisciplinary approach. You need to pay attention to their bones. In the first 100 days post transplant, the average bone aging is 17 years.
So although were trying to treat acute GVHD, viruses, and prevent relapses, [by putting] your patients on some steroids, you are aging your patients bones by 17 years only in the first 100 days. No matter what you do, give your patients vitamin D, calcium, and Fosamax [alendronate sodium].
Follow this link:
Gergis Explains the Differences Between Acute and Chronic GVHD - Targeted Oncology
- Greene, Boebert only lawmakers to vote against bone marrow transplant bill | TheHill - The Hill - April 17th, 2021
- First in the nation, FDA-approved Phase II mesenchymal stem cell therapy for Parkinson's disease begins - Newswise - April 17th, 2021
- Researchers investigate whether stem cell therapy is safe and effective for treatment-resistant bipolar disease - Newswise - April 17th, 2021
- ThermoGenesis : The History of Cell and Gene Therapy - marketscreener.com - April 17th, 2021
- Treating chronic myeloid leukemia (CML): By phase and more - Medical News Today - April 17th, 2021
- Stem cell treatment needed to fight the good fight - Victoria Lookout - April 17th, 2021
- Collaboration Furthers Understanding of Immune Cell Development | Newsroom - UC Merced University News - April 17th, 2021
- Leukemia Cutis: Symptoms and Treatment - Healthline - April 17th, 2021
- More ethnically diverse bone marrow donors needed to save lives - Mail and Guardian - April 17th, 2021
- New pediatric cancer treatment method being used in Iran - Tehran Times - April 17th, 2021
- Adipose-derived Stem Cell OverviewMarket Key Companies, Business Opportunities, Competitive Landscape and Industry Analysis Research Report by 2027 ... - April 17th, 2021
- CRISPR gene therapy for sickle cell disease approved by the FDA - BioNews - April 17th, 2021
- Researchers have created embryos that are part-human and part-monkey - The Economist - April 17th, 2021
- The Recovery Room: News beyond the pandemic April 16 - Medical News Today - April 17th, 2021
- Being bionic: the future of regenerative medicine - Toronto Star - April 17th, 2021
- 'Natural Killer Cells' and Other Promising Cancer Treatments - Barron's - April 17th, 2021
- While ElsaLys continues to work on the filing of marketing approval in Europe and the US for inolimomab, the company confirms the renew of its cohort... - April 17th, 2021
- Mouth Sores from Chemo: Symptoms, Causes, and Treatments - Healthline - February 19th, 2021
- Meet the women hoping to recruit more stem cells donors from Black communities - CTV News - February 19th, 2021
- The Untapped Potential of Cell and Gene Therapy - AJMC.com Managed Markets Network - February 19th, 2021
- Polycythemia vera life expectancy: With treatment and more - Medical News Today - February 19th, 2021
- Novartis and Gates Foundation Team Up To Deliver Affordable Sickle Cell Gene Therapy - BioSpace - February 19th, 2021
- Heartbreak for family of cancer-stricken four-year-old as stem cell donor falls ill at last minute - Press and Journal - February 19th, 2021
- Initiation of Post-Primary Tuberculosis of the Lungs: Exploring the Secret Role of Bone Marrow Derived Stem Cells - DocWire News - February 17th, 2021
- Be The Match encourages people of color to join bone marrow registry - KING5.com - February 17th, 2021
- Types of leukemia: Prevalence, treatment options, and prognosis - Medical News Today - February 17th, 2021
- Cord Blood Banking Services Market projected to expand at a CAGR of 10.9% from 2019 to 2027 KSU | The Sentinel Newspaper - KSU | The Sentinel... - February 17th, 2021
- Jasper Therapeutics Announces Launch of New Clinical Trial with National Heart, Lung, and Blood Institute to Evaluate JSP191 in Sickle Cell Disease -... - February 17th, 2021
- Apamistamab Conditioning Treatment Induces High Rates of HCT Success in AML - OncLive - February 17th, 2021
- Novartis, Gates Foundation pursue a simpler gene therapy for sickle cell - STAT - February 17th, 2021
- Bone marrow transplant shows signs of curing brave little boy with one in a million condition - Shields Gazette - February 17th, 2021
- After 13 years of trials and tribulations RTP firm G1 wins first FDA approval for cancer drug - WRAL Tech Wire - February 17th, 2021
- Global Hematological Cancers Therapeutics Market Is Expected to Reach USD 82.40 billion by 2028 : Fior Markets - GlobeNewswire - February 17th, 2021
- Stem cells efficacy confirmed in treating ototoxic hearing loss - Korea Biomedical Review - February 4th, 2021
- Understanding bone marrow transplant: The guidelines and the protocols - The New Indian Express - February 4th, 2021
- 'Whatever it takes': Stem cell drive underway to find bone marrow match for girl on Alta. First Nation - CTV Edmonton - February 4th, 2021
- Novel Bone Marrow 'Ingredient' To Help Arthritic Horses The Horse - TheHorse.com - February 4th, 2021
- World Cancer Day 2021: DKMS Announces The Milestone Of Giving 90,000 Blood Cancer Patients Worldwide A Second Chance At Life - PR Newswire India - February 4th, 2021
- Helping others helps Havard through sickness | Community | hannapub.com - The Franklin Sun - February 4th, 2021
- Why Cynata is hopeful its COVID treatment trial will succeed where others have failed - Business News Australia - February 4th, 2021
- Anti-Emetic Drug Effectively Blocks CD93 Signaling in Preclinical Evaluations, Suggesting Suitability in CML - Cancer Therapy Advisor - February 4th, 2021
- World Cancer Day 2021: What are Blood Cancers, Types, Symptoms, Treatment and data in India? - Jagran Josh - February 4th, 2021
- Man who wants to live for 180 years spends Rs 18 lakh to re-inject his own stem cells - Times Now - February 4th, 2021
- India Stem Cell Market speedy growth at US$ 1.27 Bn by 2028 with Thermofisher Scientific India, Pluristem Technologies, Becton Dickinson Private... - February 4th, 2021
- [Full text] Retrospective Study on Implantation of Autologous-Cultured Osteoblasts | ORR - Dove Medical Press - February 4th, 2021
- Orthopedic Regenerative Medicine Market Size to Witness A Lucrative Growth Over 2020-2027 | Curasan, Inc., Carmell Therapeutics Corporation, Anika... - February 4th, 2021
- World Cancer Day 2021: Know All About The Different Types Of Blood Cancer From Expert - NDTV Doctor - February 4th, 2021
- Bone Marrow Transplantation Market to Surpass US$ 15 Bn By 2027: Acumen Research And Consulting - IT News Online - February 1st, 2021
- Stem Cell Therapy Market 2021: Global Key Players, Trends, Share, Industry Size, Segmentation, Forecast To 2027 KSU | The Sentinel Newspaper - KSU |... - February 1st, 2021
- Covid-19 leads to shortage of bone marrow donors - GO! and Express - February 1st, 2021
- UTV documentary tells of young Belfast woman's lasting legacy to promote stem cell donation - The Irish News - February 1st, 2021
- What Is Leukemia: And How To Prevent It? - Technology Times Pakistan - February 1st, 2021
- A Phase I Study of CYNK-001 Immunotherapy in Adults with Acute Myeloid Leukemia in Remission with Small Amounts Remaining in the Blood - On Cancer -... - February 1st, 2021
- National Institute for Health and Care Excellence (NICE) recommends lenalidomide as a maintenance therapy for people with newly diagnosed multiple mye... - February 1st, 2021
- If I Have Cancer, Dementia or MS, Should I Get the Covid Vaccine? - Kaiser Health News - February 1st, 2021
- Adipose Derived Stem Cell Therapy Market Projected to Witness a Double-Digit CAGR During 2018 to 2026 | Coherent Market Insights - The Courier - January 23rd, 2021
- Stem Cell Therapy Market Size, Growth Opportunities, Trends, Key Players and Forecast to 2027 - The Courier - January 23rd, 2021
- Global Cell Isolation Market SWOT Analysis, Key Indicators, Forecast 2027 : Becton, Dickinson, and Company, Thermo Fisher Scientific KSU | The... - January 23rd, 2021
- 'I was excited to help somebody': Montana Western's Dylan Pope reflects on donating bone marrow - MontanaSports - January 22nd, 2021
- Mesoblast Limited: Is Stemcell Therapy Ready For Prime Time? - Sick Economics - January 22nd, 2021
- [Full text] Identification and Targeting of ThomsenFriedenreich and IL1RAP | OTT - Dove Medical Press - January 22nd, 2021
- BrainStorm Announces the Publication of Preclinical Data Highlighting the Potential of a NurOwn Derived Exosome-Based Treatment for COVID-19 ARDS -... - January 22nd, 2021
- [Full text] Effects of Caffeic Acid and Its Derivatives on Bone: A Systematic Revi | DDDT - Dove Medical Press - January 22nd, 2021
- Cancer requires more tutoring, with Meyer continuing to Teaching Cancer a lesson - News - vintontoday.com - January 22nd, 2021
- BrainStorm's Covid-19 ARDS treatment improves lung function in study - Clinical Trials Arena - January 22nd, 2021
- Comparative analysis of mouse bone marrow and adipose tissue mesenchymal stem cells for critical limb ischemia cell therapy - DocWire News - January 19th, 2021
- Brave Evie Hodgson from Sleights finally has bone marrow transplant after one last 'twist in the tale' - Yorkshire Live - January 19th, 2021
- Induction of muscle-regenerative multipotent stem cells from human adipocytes by PDGF-AB and 5-azacytidine - Science Advances - January 19th, 2021
- [Full text] Clinical Analysis of Bloodstream Infections During Agranulocytosis Aft | IDR - Dove Medical Press - January 19th, 2021
- [Full text] Osteonecrosis of the Jaw Beyond Bisphosphonates: Are There Any Unknown | CCIDE - Dove Medical Press - January 19th, 2021
- Shipyard worker Brad Lawson from Walney may have saved a stranger's life with his stem cell donation - NW Evening Mail - January 19th, 2021
- Bone Marrow Processing Systems Market- Global Research Analysis, Trends, Competitive Share and Forecasts 2018 2025 - NeighborWebSJ - January 19th, 2021
- Adipose Derived Stem Cell Therapy Market 2018: Production, Sales, Supply, Demand, Analysis and Forecast To 2026 | BioRestorative Therapies, Inc.,... - January 19th, 2021
- Bone Marrow Processing System Market: Segmental Highlights and Table of Content 2025 - NeighborWebSJ - January 19th, 2021
- Global stem cell banking market Analysis With Key Players, Applications, Trends And Forecasts 2028 - The Courier - January 19th, 2021
- Mum of girl, 8, with rare illness is in 'torture' waiting for results of vital operation - Irish Mirror - January 19th, 2021
- Bone Therapeutics and Rigenerand sign partnership for cell therapy process development - GlobeNewswire - January 19th, 2021
- Unlocking The Unlimited Potential Of Stem Cells - CodeBlue - January 9th, 2021
- Hemostemix steps into the new year with capital and its critical clinical study data in hand - InvestorIntel - January 9th, 2021
- Global Organ and Tissue Transplantation and Alternatives Market to 2024 - Impact Analysis of COVID-19 - Yahoo Finance - January 9th, 2021