Review Article

Novel Pharmacological Treatment Options of Steroid-Refractory Graft-versus-Host Disease

Table 2

A summary of the novel drugs in the treatment of SR-cGVHD.

AuthorStudy typeDrugMechanism of actionTreatment regimenORRCRSurvivalGrade 3-4 AEs

Zeiser et al.Multicenter, randomize, open-label phase 3 trialRuxolitinibJAK1 and JAK2 kinase inhibitor10 mg BID40%NRNRThrombocytopenia (33%)
Anemia (30%)
CMV infection (26%)

Carpenter et al.Open-label, multicenter, international phase 1/2 studyIbrutinibBruton tyrosine kinase inhibitor<12 years: Once daily from 120 mg/m2 to 240 mg/m2; patients older than 12 years received 420 mg77% in R/R group4% in R/R group18-months OS 91% in R/R group64% overall; pyrexia (8%),
Hypoxia (7%),
Neutropenia (7%),
Osteonecrosis (7%),
Stomatitis (7%),
ALT elevation (5%),
Hypokalemia (5%),
Pneumothorax (5%)

Cutler et al.Phase 2 randomized multicenter registration trialBelumosudilROCK2 inhibitor200 mg daily or 200 mg BIDORR 74% in 200 mg daily group; 77% in 200 mg twice daily group6% in 200 mg daily group; 3% in 200 mg twice daily group89% in 2 years54% overall; pneumonia (8%), hypertension (6%), hyperglycemia (5%), anemia (3%), neutropenia (2%)
Noriko et al.Multicenter, open label, single-arm studyIbrutinibBruton tyrosine kinase inhibitor420 mg once daily or 280 mg if concomitant voriconazole73.7%10.5%Not reached78.9% overall;
Pneumonia 21.1%
Cellulitis 15.8%
Stomatitis 10.5%
Decreased platelet count 10.5%

Chen et al.Phase 1/2 clinical trialNilotinibTyrosine kinase inhibitorFrom 200 mg to 400 mg twice daily up to the maximum tolerated dose46%0%NRAspiration pneumonia (3%)
Hyponatremia (3%)
Hypophosphatemia (10%)
Influenza B (3%)
Joint stiffness (3%)
Lipase elevation (7%)
LFTs elevation (3%)
Muscle cramping (3%)
Myocardial infarction (3%)
Neutropenia (3%)
Shingles (3%)
Pancreatitis (3%)
P. jiroveci pneumonia (3%)
URI (3%)

Kitko et al.Phase I/II open-label studyAxatilimabMonoclonal antibody to CSF-1R3 mg/kg every four week82%NR12 months FFS was 77%20% overall;
Hypertension (4%),
CPK increase (4%),
Pneumonia (3%),
AKI (2%),
AST increase (2%),
GGT increase (2%),
Lipase increase (2%),
Fever (2%)

DeFilipp et al.Phase 1 clinical trialSonidegibHedgehog signaling pathway inhibitorUp to 12 cycles of 28 days: 200 mg/day (dose level 1), 400 mg/day (dose level 2), and 600 mg/day (dose level 3)47%0%NR100% overall;
Arthralgia (18%),
Abdominal pain (18%)
Myalgia (18%)
Back pain (12%)
Headache (12%)
Hypercalcemia (12%)
Single events (6%): anemia, cardiac arrest, chest pain, congestive heart failure, diarrhea, hypertension, hypotension, port infection, skin discoloration, small bowel obstruction, and superior vena cava syndrome

Cutler et al.Open label phase 1/2 trialRituximabMonoclonal antibody to CD2038 cycles: 375 mg/m2 per week for 4 weeks70%10%NR43% overall
Infectious diarrhea (14%)
Viral conjunctivitis (5%)
Hepatitis B reactivation (5%)
Septic arthritis (5%)
GI hemorrhage (5%)
Acute infusion reaction (5%)

Whangbo et al.Single center phase 1 clinical trialIL-2Enhancement of regulatory T-cell expansionChildren: 0.33 × 106 IU/m2; adults: 0.67 × 106 IU/m2 daily82% in pediatric patients0%In 12 monthsPediatric AE: hypophosphatemia (9%)
Adults: 28.5%Pediatric patients: 91%Hypokalemia (9%)
Adults: 90%Adult AE:
Transaminitis (20%)
Infection (10%)

Curtis et al.Randomized phase 2 trialPomalidomideImmune modulator0.5 mg per day orally or 2 mg per day; maximum dose was 2 mg per day47%0%NRLymphocytopenia (28%)
Pneumonia (19%)
Hypophosphatemia (15%)
Fatigue (19%)
Maculopapular rash (3%)
Skin infection (3%)
Anemia (6%)
Limb edema (3%)
Hypotension (9%)
Increased ALT (6%)
Diarrhea (6%)
Hypertension (3%)
Leukocytopenia (3%)

ORR = overall response rate; CR = complete response; AEs = adverse events; BID = twice daily; R/R = relapsed/refractory; NR = not reported; ROCK2 = Rho-associated coiled-coil–containing protein kinase 2; CPK = creatinine phosphokinase; AST = aspartate aminotransferase; GGT = gamma-glutamyl transferase; AKI = acute kidney injury.