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8h

Did you know?

Steroid-refractory acute graft-versus-host disease (aGVHD) carries a mortality exceeding 50%, and no standard second-line therapy had been established until recently. The REACH2 Phase 3 trial (n=309 patients with steroid-refractory grade II–IV aGVHD) demonstrated that JAK1/2 inhibition achieved an overall response rate of 62% at Day 28 vs. 39% with best available therapy (OR 2.64; p<0.001), with significantly higher rates of durable response at Day 56 and meaningful reductions in non-relapse mortality.

NCCN Guidelines
Discussion question

How has the REACH2 data changed your institutional approach to second-line management of steroid-refractory acute GVHD — and how are you monitoring for and managing the most clinically significant adverse events with JAK inhibition in this setting?

  • 8h
    Still remains as a second-line management for steroid refractory situations. Still need to watch for toxicity as well as serologic monitoring for transaminases and blood cell count changes
  • Yesterday
    REACH2 has made ruxolitinib my preferred second-line option for steroid-refractory acute GVHD when appropriate. I monitor closely for cytopenias, infections, and viral reactivation, particularly CMV, as well as liver abnormalities. Supportive care includes antimicrobial prophylaxis and regular blood counts and viral monitoring. If significant toxicity develops, I adjust or hold the dose as needed while balancing GVHD control against the risks of treatmAnt
  • 2d
    This is the updated REACH2 data (5 year f/u)

    Jakafi his kept it's efficacy over BAT. It has become our leading 2nd line option in GVDH
    • Ruxolitinib Versus Best Available Therapy in Patients With Steroid-Refractory Acute Graft-Versus-Host Disease: Final Analysis From the Randomized Phase III REACH2 Trial

    Ruxolitinib Versus Best Available Therapy in Patients With Steroid-Refractory Acute Graft-Versus-Host Disease: Final Analysis From the Randomized Phase III REACH2 Trial

    Source : https://ascopubs.org/doi/10.1200/JCO-25-00809

    Approximately 30%-50% of patients develop acute graft-versus-host disease (aGVHD) after allogeneic hematopoietic cell transplantation (Allo-HCT), representing a major limitation of this treatment. Although corticosteroids remain the standard first-line ...

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