GVHD
Published on January 14, 2025
Preventing GVHD and CRS after haplo-HCT with itacitinib
by ASH Publications
Abboud R, Schroeder MA, Rettig MP, et al. Itacitinib for Prevention of Graft-Versus-Host Disease and Cytokine Release Syndrome in Haploidentical Transplantation. Blood. 2024; (doi: 10.1182/blood.2024026497).
Clinical trial evidence supports the use of itacitinib plus routine prophylaxis to prevent graft-versus-host disease (GVHD) and cytokine release syndrome (CRS) following haploidentical hematopoietic cell transplantation. Itacitinib selectively inhibits Janus kinase-1, a signaling pathway for the cytokines IFN-γ; and IL-6 — which both are implicated in the pathophysiology of GVHD and CRS. In the single-group study, 42 patients received 200 mg of itacitinib daily from day -3 through day +100 or +180, followed by tapering. Follow-up found the approach was well-tolerated and generated favorable outcomes without undermining the engraftment process. CRS was kept in check, with 22% and 78% of the sample experiencing grade 0 and grade 1 CRS, respectively, but no cases grade 2 or higher CRS. Similarly, through day +180, none of the study participants presented with grade 3-4 acute GVHD; and the 1-year cumulative rate of moderate or severe chronic GVHD was just 5%. The study authors also reported 1-year overall survival was 80% and a 2-year cumulative relapse rate of 14%.
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