Acute graft-versus-host disease (aGVHD) is a severe complication following allogeneic hematopoietic stem cell transplantation (allo-HSCT) and is a major cause of non-relapse mortality in patients with hematologic malignancies. Although treatment options for aGVHD have advanced in recent years, the prognosis remains poor. Recently, the “13th National Hematopoietic Stem Cell Transplantation Academic Conference of the Chinese Medical Association,” hosted by the Chinese Medical Association and organized by the National Clinical Research Center for Hematologic Diseases – Peking University Institute of Hematology, was held from March 1st to 3rd, 2024, in Beijing. Following the conference, Oncology Frontier – Hematology Frontier had the honor of inviting Professor Erjie Jiang, Director of the Stem Cell Transplantation Center at the Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Science, to share insights on the challenges, risk factors, and diagnostic and therapeutic advances in acute graft-versus-host disease (aGVHD).
Oncology Frontier – Hematology Frontier: Acute graft-versus-host disease (aGVHD) is a severe complication following allogeneic hematopoietic stem cell transplantation (allo-HSCT) and a major cause of non-relapse mortality after transplantation. Could you please introduce the challenges faced by China in the management of aGVHD?
Professor Erjie Jiang: Acute graft-versus-host disease (aGVHD) is indeed a very severe complication following allogeneic hematopoietic stem cell transplantation (allo-HSCT), which may lead to death in 15% to 20% of patients post-transplantation. Therefore, colleagues in the field of hematopoietic stem cell transplantation attach great importance to it. Over the past twenty years, we have conducted many related studies and explorations, but there are still many problems to be solved and many challenges to be overcome regarding aGVHD. For example, the diagnosis of aGVHD is mainly based on its clinical symptoms and biochemical indicators, and there is still a lack of more accurate and diagnostic value-based diagnostic criteria. The prevention of aGVHD is also a challenging issue in the field. This includes how to prevent its occurrence before the symptoms of aGVHD appear by using biomarkers for early intervention. Although there have been some breakthroughs and progress in prevention drugs in recent years, the incidence of severe aGVHD in haploidentical HSCT still reaches 10% or even more than 20%. Another challenging issue is the treatment of steroid-resistant severe aGVHD. There are many recommended regimens for second-line treatment, but currently, drugs such as basiliximab and ruxolitinib have an overall response rate of 70% to 80% and a complete response rate of around 50%, which is not ideal. So, there are still many challenges in the treatment of acute graft-versus-host disease, and we look forward to more effective and safer drugs to treat steroid-resistant aGVHD.
Oncology Frontier – Hematology Frontier: aGVHD has a rapid onset and is highly dangerous, with prevention being the primary focus. Could you please discuss the risk factors leading to aGVHD? And how can aGVHD occurrence be effectively prevented?
Professor Erjie Jiang: There are many risk factors leading to acute graft-versus-host disease (aGVHD), and the degree of HLA matching is the most important risk factor affecting its occurrence. Advanced age of donors and recipients, as well as patients with refractory acute leukemia, are high-risk factors for the occurrence of aGVHD. Other factors, such as female donors, can also lead to the occurrence of aGVHD. Regarding the prevention of aGVHD, there are many classic drugs, including cyclosporine (CsA), methotrexate, and mycophenolate mofetil. New drugs include ruxolitinib and ATG (anti-thymocyte globulin), but overall, there is still no way to completely prevent the occurrence of aGVHD. Therefore, this field requires more exploratory research.
Oncology Frontier – Hematology Frontier: Accurate diagnosis and timely treatment are key to successful treatment of aGVHD. Could you please discuss how to grade the severity of aGVHD, assess efficacy, and choose treatment drugs?
Professor Erjie Jiang: Regarding the accurate diagnosis of acute graft-versus-host disease (aGVHD), as I mentioned earlier, we need more molecular markers, protein markers, and other complications for differential diagnosis. In terms of treatment, including first-line and second-line treatment, especially first-line treatment, there have not been many advances in the past twenty years, and glucocorticoids are still the mainstay. However, the response rate of glucocorticoids is around 60%, and there are also many adverse reactions, so we are also exploring more new drugs in this direction. Many colleagues at home and abroad are exploring the prevention of acute graft-versus-host disease (aGVHD), and we mainly rely on the establishment of some prevention models through current artificial intelligence and machine learning methods, believing that there will be some breakthroughs in the coming years.
Professor Erjie Jiang
Doctor of Medicine, Chief Physician, Doctoral Supervisor (Post)
Director of the Stem Cell Transplantation Center, Chinese Academy of Medical Sciences Hematology Hospital (Institute of Hematology)
Chairman of the Hematopoietic Stem Cell Transplantation Committee of the China Primary Health Care Foundation
Leader of the Leukemia Autologous Transplantation Collaboration Group of the China Hematological Disease Specialized Alliance
Deputy Leader of the Hematopoietic Stem Cell Application Group of the Hematology Branch of the Chinese Medical Association
Standing Committee Member of the Hematological Oncology Professional Committee of the Chinese Anti-Cancer Association, Deputy Leader of the Hematopoietic Stem Cell Transplantation and Cell Therapy Group
Deputy Leader of the CSCO Hematopoietic Stem Cell Transplantation Working Group
Executive Director of the Tianjin Anti-Cancer Association
Vice Chairman of the Tianjin Blood and Regenerative Medicine Society
Editorial Board Member of Chinese Journal of Hematology, Leukemia & Lymphoma, and other journals.
