A New Era of GVHD Prevention Post-HCT
NMDP Explore Cell Therapy podcast season 2, episode 9
In this two-part "Explore Cell Therapy" podcast episode, Javier Bolaños-Meade, MD, and Shernan Holtan, MD, discuss advances and innovations in graft-versus-host disease (GVHD) prevention that call for a new standard of care in patients needing allogeneic hematopoietic cell transplantation (HCT).
Listen as they share details of their recently published clinical trial research outlining a novel drug combination for GVHD prevention. They highlight the history of GVHD prevention and the impacts of post-transplant cyclophosphamide in particular. Together, we examine the importance of this work to help address barriers to care and access gaps, the significance of early and ongoing communication between transplant centers and community practice teams, and the magnitude of continued clinical trials research. You will gain valuable insights that these clinicians urge you to consider in your practice to advance GVHD prevention and improve patient outcomes and post-HCT quality of life.
Key takeaways from A New Era in GVHD Prevention Post-HCT episode
- Changing standards and outcomes in GVHD prevention: Researchers observed results that support a clinical paradigm shift towards post-transplant cyclophosphamide (PTCy), tacrolimus (Tac) and mycophenolate mofetil (MMF) as the new standard of care according to recent results of the Blood and Marrow Clinical Trials Network (BMT CTN) 1703. New combinations are emerging, with PTCy playing an especially important role in shifting the paradigm for GVHD prevention in matched and mismatched donor settings. Today, the severity and incidence of GVHD is nothing like it was 20 years ago, largely thanks to PTCy.
- Closing gaps in access: New GVHD prevention strategies can help close gaps in access and outcomes related to race and ethnicity. PTCy alone has revolutionized the field with the ability to use haploidentical and mismatched donors sources with greatly reduced incidence and severity of GVHD. These improved outcomes. along with additional stem cell sources like umbilical cord blood, now allow for nearly every patient to find a suitable donor when necessary.
- BMT CTN 1703 results and composite endpoints: Composite primary endpoints in this study capture what it means to go through a transplant without major complications. Researchers wanted to see show that outcomes that matter to patients and affect quality of life could be improved by PTCy, Tac and MMF. The magnitude of the benefit was substantial and supported the use of transplant in older patients who historically would not have been considered candidates.
- Communication is key: Communication between transplant centers and referring community physicians is crucial for cohesive patient care, survivorship planning and overall outcomes. Telemedicine has become increasingly important to ensure the continuum of care for patients, although it can be difficult to examine patients with GVHD this way.
- Future research and innovation: There is ongoing work in new combinations for GVHD prevention and refining the strategy as much as possible. Though the current HCT mortality rate is low, relapse is an area of current and future focus. Exploring maintenance therapies, conditioning techniques and even clinical trials that go beyond cancer treatment are all on the horizon.
This episode's expert guests
Javier Bolaños-Meade, MD
Professor of Oncology, Hematologic Malignancies
Clinical Director of Bone Marrow Transplant
The Johns Hopkins Sidney Kimmel Comprehensive Cancer Center
Shernan Holtan, MD
Associate Professor of Medicine
Clinical/Translational Investigator
Division of Hematology, Oncology, and Transplantation
University of Minnesota
Dr. Bolaños-Meade has devoted his career to the development of effective therapies to prevent and treat GVHD, including the ability to perform safe transplants between mismatched donor-recipient pairs, related and unrelated.
Dr. Holtan’s research focuses on designing non-immunosuppressive supportive therapies and monitoring strategies for inflammatory complications of transplant and cell therapy. Her ongoing studies include pathways associated with prognosis in GVHD.
Featured programs discussed in this episode
- Post-Transplantation Cyclophosphamide-Based Graft-Versus-Host Disease Prophylaxis (The New England Journal of Medicine, 2023)
- Three prophylaxis regimens (tacrolimus, mycophenolate mofetil, and cyclophosphamide; tacrolimus, methotrexate, and bortezomib; or tacrolimus, methotrexate, and maraviroc) versus tacrolimus and methotrexate for prevention of graft-versus-host disease with haemopoietic cell transplantation with reduced-intensity conditioning: a randomised phase 2 trial with a non-randomised contemporaneous control group (BMT CTN 1203) (The Lancet Hematology, 2019)
- Age is No Barrier for Adults Undergoing HCT for AML in CRA: Contemporary CIBMTR Analysis (Bone Marrow Transplantation, 2022)
- Post-Transplant Cyclophosphamide, Tacrolimus, and Mycophenolate Mofetil as the New Standard for Graft-Versus-Host Disease (GVHD) Prophylaxis in Reduced Intensity Conditioning: Results from Phase III BMT CTN 1703 (Blood, 2022)
- Phase II Study of Myeloablative 7-8/8-Matched Allotransplantation with Post-Transplantation Cyclophosphamide, Tacrolimus, and Mycophenolate Mofetil (Transplantation and Cellular Therapy, 2023)
- 3-Year Outcomes Remain Very Good in Mismatched Unrelated Donor HCT Patients, Highlighting Potential to Expand Access (Bone Marrow Transplantation, 2022)
Resources for hematology/oncology and transplant physicians
HCT Guidelines app
The new and improved HCT Guidelines app features our latest HCT Consultation Timing Guidelines, Post-Transplant Care Guidelines, tips to help identify GVHD, CME opportunities and more.
Transplant Center Directory for hematology/oncology physicians
This searchable database provides details on the transplant centers, such as center contact information, number of transplants by cell source, patient survival information and more.
Access the Transplant Center Directory
CIBMTR® Summary Slides and Reports
Use summarized CIBMTR data on outcomes and trends for clinical decision-making, presentations and research planning. CIBMTR is a research collaboration between the Medical College of Wisconsin® and NMDPSM.
Resources for your patients
NMDP Patient Support Center
Patients, caregivers and families receive free support, information and resources before and after transplant from our NMDP Patient Support Center team.
Get Patient Support Center details
Jason Carter Clinical Trials Search and Support (CTSS)
The CTSS program helps patients find and join clinical trials through one-on-one support and an easy-to-navigate website. Patients can receive financial assistance to help pay for travel costs to participate in a clinical trial.