Thinking Out of the Box to Advance the Management of Chronic Graft-vs-Host Disease

Get Permission

Over the past decade, the field of allogeneic hematopoietic cell transplantation has made great strides, evolving into a curative procedure for blood cancers that once were almost always fatal. However, chronic graft-vs-host disease, whose biologic etiology remains unclear, continues to be the major cause of nonrelapse mortality and nagging clinical complications in patients with hematologic cancer who undergo successful transplantation. To advance the field of graft-vs-host disease, the National Institutes of Health (NIH) will host the 3rd NIH Chronic GvHD Consensus Conference as a virtual meeting from November 18 to 20. It will include approximately 100 contributing experts from the international transplant community.

Virtual Venue: Larger Attendance Expected

Chronic graft-vs-host disease is a complex and heterogeneous process whose fundamental biologic roots are still unclear. This is the third NIH consensus conference; the first was held in 2004 and the second, in 2014. The work from this NIH-spearheaded effort has resulted in validation and universal acceptance of the NIH criteria for diagnosis, staging, and measurement of therapeutic response, which have led to U.S. Food and Drug Administration (FDA) approval of new therapies for chronic graft-vs-host disease in 2017.

“Unlike the long-term complications we see with other malignancy therapies, in bone marrow transplant, we actually create a new autoimmune condition, chronic graft-vs-host disease. Naturally, because of the COVID pandemic, this conference will be held virtually; as a result, we expect to have a larger attendance, simply because people will just need to log in online,” said pediatric transplant expert Kirk Schultz, MD, who is a member of the NIH Conference’s Steering Committee. Dr. Schultz is Professor in the Division of Hematology and Oncology in the Department of Pediatrics, Faulty of Medicine, at the University of British Columbia, Vancouver.

“This meeting has set the bar for state-of-the-art practice in bone marrow transplantation.”
— Kirk Schultz, MD

Tweet this quote

Dr. Schultz continued: “In the 2020 conference, we’ve put more effort into the patient-caregiver population and have devoted an entire patient advocacy summit. During this summit, we will discuss the challenges these patients and their caregivers face dealing with this daunting medical condition, such as the psychological impact of chronic graft-vs-host disease and the issues of survivorship and long-term care.”

“We expect a robust conference, and we already have more than 400 attendees lined up to participate in the proceedings,” added Dr. Schultz. “The four working group sessions will cover the full spectrum of issues and review the progress on key papers that the groups have been planning since the initial planning meeting in 2019,” he added. “This meeting has become the standard method for dealing with the long-term complications of bone marrow transplantation. It has set the bar for state-of-the-art practice in this field.”

‘A New Disease Entity’

The ASCO Post also spoke with one of the principal’s behind this conference, Steven Z. Pavletic, MD, MS, Head of the Graft-vs-Host Disease and Late Effects Section of the Center for Cancer Research at the National Cancer Institute. “Immunology has taken the oncology community by storm over the past several years; however, the best proven immunotherapy that has curative results is hematopoietic allogeneic stem cell transplantation. We began to tackle graft-vs-host disease because we wanted to cure leukemia, and not treat it as a chronic disease. In the early 2000s, it became clear that we needed to treat this complication as a new disease entity.”

“Given that many more of our patients will be moving into survivorship, we need the oncology community more than ever to be part of the continuum of care.”
— Steven Z. Pavletic, MD, MS

Tweet this quote

Dr. Pavletic continued: “We know how to stage cancers, but nobody knows how to stage chronic graft-vs-host disease or how to prognosticate and choose the right therapies. This has been a collaborative effort, but I would like to give special credit to Georgia Vogelsang, MD, who is a leader in the field and helped me start the series of graft-vs-host disease consensus conferences. Our first direction was to create graft-vs-host disease guidelines for clinical trials. As we moved forward, we accumulated a lot more knowledge about the disease, which culminated in 2017 when the FDA granted accelerated approval to ibrutinib, the first drug approved specifically for chronic graft-vs-host disease.”

Pursuit of Collective Knowledge

Dr. Pavletic noted that numerous challenges have impeded progress toward better understanding and management of chronic graft-vs-host disease. The current standard-of-care for chronic graft-vs-host disease has not changed over the years, and transplant clinicians still rely on corticosteroids as the mainstay of treatment. “The primary goal of this consensus conference is to gather all of our acquired knowledge into this collective setting and begin making decisive changes in the clinical outcomes of our patients. To that end, we are confident to project real advances in our diagnosis and treatment of this disease within 5 to 7 years,” he noted.

The transplant community’s exhaustive work on chronic graft-vs-host disease has reached the point that collaboration with ASCO is needed to reach the general oncology community, Dr. Pavletic explained. “Transplant patients are cancer survivors facing difficult problems who need care in the community setting,” he said. “We are hoping this round of consensus meetings will be the impetus to create treatment guidelines, which to date do not exist for chronic the graft-vs-host disease community. It is important to note, that after years of working on the issue of donors for allogeneic transplant, we have reached a milestone: Every patient in need of a transplant can now be matched with a donor. So, given that many more of our patients will be moving into survivorship, we need the oncology community more than ever to be part of the continuum of care,” said Dr. Pavletic.

Reaching Out to the Oncology Community

Dr. Schultz commented: “Chronic graft-vs-host disease is an orphan disease that is difficult to diagnose and treat and can have a rapid onset of serious symptoms, almost overnight. And those in the general oncology community who do not have training or experience in this disease will be the physicians seeing these patients after they have completed their transplantation procedure, as they may still need multimodality therapies. The mortality rate in adults with chronic graft-vs-host disease is upward of 30%, and for those who survive, graft-vs-host disease creates lifelong debilitating conditions. So, the other challenge in this difficult clinical scenario is to educate the general oncology community about the special treatment needs of their patients with cancer who have undergone allogeneic transplantation.”

Dr. Pavletic added: “To date, the primary focus of the transplant community has been on research and gaining as much scientific knowledge about chronic graft-vs-host disease as possible, to develop more effective therapies and preventions. However, we now realize we have not put enough effort into organizing and disseminating vital information to the oncology community and their patients. So, at this conference, we will spend the first 2 days reviewing selected papers on issues such as diagnosis and preemptive treatment of chronic graft-vs-host disease. On day 3, we will focus on the industry summit, discussing ways to enhance our clinical trial presence and, equally important, a patient advocacy workshop, which will allow us to share ideas about how best to get educational material into the hands of oncologists and their patients with cancer who have had transplants.”

Asked to share a closing thought on the mission and goals of the 2020 Chronic GvHD Consensus Conference, Dr. Schultz responded: “Everyone involved in this effort sees this as the next step in taking these patients who have been cured of their hematopoietic malignancies and giving them better quality of life moving forward. And this NIH consensus conference will help us accelerate that goal.”

Access to the workshop is free. To register, visit

Watch for more about this NIH conference on chronic graft-vs-host disease in future issues of The ASCO Post