Navigating Second-Line Decisions: Real-World Management of Chronic Graft-Versus-Host Disease (GVHD)
Video Transcript
Moderator: Welcome to today’s episode of our podcast series. I’m Jenny Lamberts with Oncology Learning Network, and I’m delighted to have you with us. This program is designed specifically for oncologists and transplant specialists, focusing on the evolving landscape of chronic graft-versus-host disease management.
Our discussion today aims to clarify an important question: Which option should we choose for second-line therapy for patients with chronic GVHD?
To explore this intriguing issue, we’re joined by Dr Shernan Holtan, who brings deep expertise in the management of chronic GVHD. She will use a patient case to discuss how—in day-to-day practice in the real world—she navigates the treatment landscape for patients with chronic GVHD with troubling symptoms who need a treatment option beyond corticosteroid or other first-line choices.
Hi, Dr Holtan. Welcome to today’s discussion. Please take it away!
Dr Holtan: I'm Shernan Holtan. I'm the chief of blood marrow transplant at Roswell Park Comprehensive Cancer Center.
So, I have a 52-year-old man who underwent peripheral blood stem cell transplantation from an HLA-matched sibling donor for high-risk myelodysplastic syndrome. By 9 months post-transplant, he developed multi-organ chronic graft-versus-host disease. This involved his skin with an erythematous rash that eventually progressed to some sclerosis; oral mucosa, which included painful ulcers and sensitivity in his mouth; ocular involvement, which included dry eyes, pain, and sensitivity; as well as the GI tract, which resulted in diarrhea and abdominal cramping.
He was initially treated at this presentation with first-line sirolimus and prednisone. This provided some partial improvement, but sirolimus was ultimately discontinued due to concerns of peripheral edema, as well as cytopenias. Subsequently, ibrutinib was initiated for the persistent rash and mucosal disease. This also led to some clinical improvement, but the patient had worsening diarrhea. That actually got to be so significant he had to stop the drug.
When the disease flared again, he was started with ruxolitinib. This provided control of his symptoms. Thank you for considering this patient case.
Moderator: Thank you, Dr Holtan, for walking us through that patient case and showing how real-world practice decisions unfold when patients with chronic GVHD develop troubling symptoms.
As your discussion highlighted, moving beyond corticosteroids or other first-line therapies is rarely a straightforward choice. It requires careful symptom classification, clinical judgment, and understanding how trial definitions do—or sometimes do not—translate directly into practice.
For clinicians, the takeaway is clear: accurate, consistent symptom assessment remains central to deciding how and when to escalate therapy. By grounding treatment decisions in evidence and patient experience, we can better navigate the complex landscape of chronic GVHD management and improve outcomes for those with this challenging condition.
On behalf of our team, thank you for joining us for this episode.
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