Onkológia 4/2022

Ruxolitinib for GvHD treatment

Allogeneic hematopoietic stem cell transplantation (HSCT) is a potentially curative treatment option for a variety of hematologic malignancies and several nonmalignant hematologic diseases. Acute and chronic graft-versus-host disease (GvHD)| remains the leading cause of morbidity and mortality after HSCT. GvHD is a multisystemic disease, which affects several organs including skin, lungs, gut, hepatobiliary and musculosceletal system. It is initiated when alloreactive donor immune cells recognize immunologically disparate antigens in the host despite the use of standard immunosupressive prophylaxis. Corticosteroids are the first - line treatment for GvHD. Steroid - refractory (SR) GvHD remains serious medical issue with high morbidity and mortality rates. Until recently, there has been no consensus on standard second – line treatment. An important step forward offers ruxolitinib, the first oral selective inhibitor of Janus kinase (JAK) 1/2. Its approval by Europen Medicines Agency (EMA) was based on two prospective open labeled, multricentric phase 3 clinical trials REACH2 and REACH3. Ruxolitinib has shown a significant response in SR acute GvHD in adult and pediatric patients aged 12 years and older, and SR chronic GvHD. Early diagnosis and treatment of GvHD are the key factors to successful transplant outcome.

Keywords: allogeneic hematopoietic stem cell transplantation, immunosupression, graft – versus – host disease, corticosteroid, refractory disease, ruxolitinib, overall response rate