Accreditation/Credit Designation

Physicians' Education Resource®, LLC, is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Physicians' Education Resource®, LLC, designates this enduring material for a maximum of 1.5 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Acknowledgment of Commercial Support

This activity is supported by educational grants from Bristol-Myers Squibb, Incyte Corporation, and Mallinckrodt Pharmaceuticals, Inc.

Medical Crossfire®: New Frontiers in the Management of GvHD: Uncovering the Latest Advances to Improve Post-Transplant Care

Release Date: May 31, 2018
Expiration Date: May 31, 2019
Media: Internet - based

 

Medical Crossfire® Overview

Medical Crossfire®: New Frontiers in the Management of GvHD: Uncovering the Latest Advances to Improve Post-Transplant Care features 4 faculty members who are experts in treating patients with graft-vs-host disease (GvHD). This online continuing medical education activity includes a discussion of the differences between acute and chronic GvHD and the associated treatment challenges and controversies. A thought-provoking case study is also presented to demonstrate individualized care in patients with GvHD.

Those who participate in this program should be better prepared to:

  • Describe the biologic phases of chronic GvHD
  • Identify common risk factors for GvHD
  • Review current and emerging treatment options a patient with GvHD
  • Identify patients with GvHD who should be encouraged to enroll in a clinical trial

 

Acknowledgement of Commercial Support

This activity is supported by educational grants from Bristol-Myers Squibb, Incyte Corporation, and Mallinckrodt Pharmaceuticals, Inc.

Requirements for Successful Completion

  • You will need to login to participate in the activity.
  • Each presentation may contain an interactive question(s). You may move forward through the presentation; however, you may not go back to change answers or review videos/content until you finish the presentation.
  • At the end of the activity, “educational content/video” will be available for your reference.
  • In order to receive a CME certificate, participants must complete the activity.
  • Complete the posttest and pass with a score of 70% or higher, complete the evaluation and then click on request for credit. Participants may immediately download a CME certificate upon completion of these steps.


Target Audience for Medical Crossfire®: New Frontiers in the Management of GvHD: Uncovering the Latest Advances to Improve Post-Transplant Care

This educational activity is directed toward medical oncologists, hematologists, and fellows who treat patients with hematologic malignancies. Nurse practitioners, nurses, physician assistants, pharmacists, researchers, and other healthcare professionals interested in the treatment of hematologic malignancies are also invited to participate.

Learning Objectives

At the conclusion of this activity, you should be better prepared to:

  • Explain the pathogenesis of GvHD and guidelines to assess, stage, and manage patients with GvHD
  • Describe methods to prevent the occurrence of GvHD in the care of patients who undergo hematopoietic stem cell transplantation
  • Assess recent results concerning emerging therapies for GvHD management, and place this evidence into the context of evolving treatment standards
  • Detail evolving biomarkers that can facilitate the identification of chronic GvHD and the probability of response to current and emerging targeted strategies


Faculty, Staff, and Planners' Disclosures

Moderator

Corey Cutler, MD, MPH, FRCP(C)
Associate Professor of Medicine
Harvard Medical School
Division of Hematologic Oncology
Dana-Farber Cancer Institute
Boston, MA

Disclosure: Consultant: Pfizer, Incyte, Kalytera, Cellect Bio, Pharmacyclics, Elsalys, Fate, BMS, Kadmon; Speakers Bureau: prIME Oncology, i3 Health

Faculty

James Ferrara, MD, DSc
Ward-Coleman Chair in Cancer Medicine
Director, Hematologic Malignancies Translational Research Center
The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai
New York, NY
 

Disclosure: Consultant: VIRACOR; Other: Intellectual Property (Patent) Rights to use of biomarkers for GvHD

Muna Qayed, MD, MSc
Associate Professor of Pediatrics
Emory University
Clinical Director, Cell and Gene Therapy Program
Children’s Healthcare of Atlanta
Atlanta, GA

Disclosure: Dr. Qayed has no relevant financial relationships with commercial interests to disclose.

Nelson Chao, MD, MBA
Donald D. and Elizabeth G. Cooke Professor
Professor of Medicine/Immunology/Pathology
Chief, Division of Hematologic Malignancies and Cellular Therapy/BMT
Director, Global Cancer
Duke Global Health Institute
Durham, NC

Disclosure: Dr. Chao has no relevant financial relationships with commercial interests to disclose.

The staff of Physicians' Education Resource®, LLC have no relevant financial relationships with commercial interests to disclose.

Disclosure Policy and Resolution of Conflicts of Interest (COI)

As a sponsor accredited by the ACCME, it is the policy of PER® to ensure fair balance, independence, objectivity, and scientific rigor in all of its CME activities. In compliance with ACCME guidelines, PER® requires everyone who is in a position to control the content of a CME activity to disclose all relevant financial relationships with commercial interests. The ACCME defines “relevant financial relationships” as financial relationships in any amount occurring within the past 12 months that creates a COI.

Additionally, PER® is required by ACCME to resolve all COI. PER® has identified and resolved all COI prior to the start of this activity by using a multistep process.

Off-Label Disclosure and Disclaimer

This CME activity may or may not discuss investigational, unapproved, or off-label use of drugs. Participants are advised to consult prescribing information for any products discussed. The information provided in this CME activity is for continuing education purposes only, and is not meant to substitute for the independent medical judgment of a physician or nurse relative to diagnostic, treatment, or management options for a specific patient's medical condition.

The opinions expressed in the content are solely those of the individual faculty members and do not reflect those of PER® or any of the companies that provided commercial support for this activity.

PER Pulse™ Recaps

1 of 3
Insights from Muna Qayed, MD, MSc – PER Pulse Recap:
Medical Crossfire®: New Frontiers in the Management of GvHD:
Uncovering the Latest Advances to Improve Posttransplant Care

In this continuing medical education–certified activity, Medical Crossfire®: New Frontiers in the Management of GvHD: Uncovering the Latest Advances to Improve Posttransplant Care, expert faculty join program chair Corey Cutler, MD, MPH, Associate Professor of Medicine, Harvard Medical School and Director of Clinical Research, Stem Cell Transplantation, to discuss the differences between acute and chronic graft-versus-host disease (GvHD), the associated treatment challenges and controversies, and a thought-provoking case study regarding individualized care in patients with GvHD.

This first of 3 PER Pulse™ Recaps summarizing the online program focuses on standard treatments for patients with GvHD, newer and emerging treatments, and the layering or combining of medical treatments, as well as prophylactic treatment and risk stratification in a patient case. Below are some highlights from the activity featuring Muna Qayed, MD, MSc, an associate professor of pediatrics at Emory University and clinical director of the cell and gene therapy program at Children’s Healthcare of Atlanta:

  • A review of the standard prophylactic regimens for GvHD,1 including calcineurin inhibitors with methotrexate or mycophenolate mofetil and T-cell–depleting antibodies antithymocyte globulin and alemtuzumab, as well as newer agents, such as the CCR5 inhibitor maraviroc, the proteasome inhibitor bortezomib, and the anti-CTLA4 antibody abatacept
  • Faculty approaches to choosing GvHD prophylaxis for a 49-year-old woman with FLT3-mutated acute myeloid leukemia being treated with busulfan and cyclophosphamide, followed by peripheral stem cell transplantation (SCT) from an unrelated donor with 8/8 matching human leukocyte antigens (HLAs)
  • Discussion of prophylaxis approaches specific to adults versus pediatric patients and to 7/8 versus 8/8 HLA-matched SCTs, as well as the importance of clinical trials for GvHD prophylaxis to help address critical unmet needs for patients receiving an SCT
  • An overview of risk stratification in this patient population, including the potential biomarkers Reg3 and ST2 and observational data supporting their role in the early detection of patients at high risk for GvHD2

“[Despite having a] standard regimen for GvHD prophylaxis, the GvHD rates are still significant. It offers a 30% to 35% risk of acute GvHD in matched sibling donors and over 50% risk of GvHD in unrelated donor transplants. There is a need for modifying or adding on to this regimen or improving the rates.”
— Muna Qayed, MD, MSc

References
  1. Ruutu T, Gratwohl A, de Witte T, et al. Prophylaxis and treatment of GVHD: EBMT-ELN working group recommendations for a standardized practice. Bone Marrow Transplant. 2014;49(2):168-173. doi: 10.1038/bmt.2013.107.
  2. Ali AM, DiPersio JF, Schroeder MA. The role of biomarkers in the diagnosis and risk stratification of acute graft vs host disease (aGvHD): a systematic review. Biol Blood Marrow Transplant. 2016;22(9):1552-1564. doi: 10.1016/j.bbmt.2016.04.022.

2 of 3
Insights from James Ferrara, MD, DSc – PER Pulse™ Recap:
Medical Crossfire®: New Frontiers in the Management of GvHD:
Uncovering the Latest Advances to Improve Posttransplant Care

As a follow-up to the continuing medical education–certified activity, Medical Crossfire®: New Frontiers in the Management of GvHD: Uncovering the Latest Advances to Improve Posttransplant Care, this second of 3 PER Pulse™ Recaps summarizing the online program focuses on management approaches for steroid-refractory acute graft-versus-host disease (GvHD). Below are some highlights from the activity featuring Dr. Ferrara, MD, DSc, Professor of Medicine, Hematology and Medical Oncology at Icahn School of Medicine at Mount Sinai:

  • Discussion of steroid use in acute GvHD, including recent data supporting the use of biomarkers to tailor therapy and predict long-term outcomes,1 and an ongoing phase II clinical trial (NCT02806947)2 investigating single-agent sirolimus versus prednisone for frontline treatment of standard-risk, acute GvHD
  • Approaches to treating steroid-refractory acute GvHD in a 49-year-old woman with FLT3-mutated acute myeloid leukemia post stem cell transplant with worsening diarrhea and skin reactions, including extracorporeal photopheresis and steroid tapering
  • • Ongoing trials of promising steroid-refractory acute GvHD treatments, such as the serine protease inhibitor alpha-1 antitrypsin3 and monoclonal antibody vedolizumab4

“I think our goal should be to move away from steroids, because we know how disruptive [they are] to the reconstituting immune system….For all patients with acute GvHD, even if you don’t know their biomarker status, it’s important to try to intervene early, because waiting for something to become steroid resistant is a losing strategy.”
— James Ferrara, MD, DSc

References
  1. Major-Monfried H, Renteria AS, Pawarode A, et al. MAGIC biomarkers predict long-term outcomes for steroid-resistant acute GVHD. Blood. 2018;131(25):2846-2855. doi: 10.1182/blood-2018-01-822957.
  2. ClinicalTrials.gov. A Study to Evaluate Steroid-free Treatment for Standard-Risk aGVHD (BMT CTN 1501). https://clinicaltrials.gov/ct2/show/NCT02806947. Published June 21, 2016. Accessed April 12, 2019.
  3. Magenau JM, Goldstein SC, Peltier D, et al. α1-Antitrypsin infusion for treatment of steroid resistant acute graft-versus-host disease. Blood. 2018;131(12):1372-1379. doi: 10.1182/blood-2017-11-815746.
  4. Coltoff A, Lancman G, Kim S, Steinberg A. Vedolizumab for treatment of steroid-refractory lower gastrointestinal acute graft-versus-host disease. Bone Marrow Transplant. 2018;53(7):900-904. doi: 10.1038/s41409-018-0094-8.

3 of 3
Insights from Corey Cutler, MD, MPH - PER Pulse™ Recap:
Medical Crossfire®: New Frontiers in the Management of GvHD:
Uncovering the Latest Advances to Improve Posttransplant Care

As a follow-up to the continuing medical education–certified activity, Medical Crossfire®: New Frontiers in the Management of GvHD: Uncovering the Latest Advances to Improve Posttransplant Care, this third of 3 PER Pulse™ Recaps summarizing the online program focuses on the staging, grading, and second-line treatment of chronic graft-versus-host disease (GvHD). Below are some highlights from the activity featuring Dr. Cutler:

  • An overview of the National Institutes of Health Individual Organ Severity Scoring system for new-onset, chronic GvHD and available treatment strategies for local and systemic therapy1 (Figure)
  • Faculty discussion of the available treatment options for chronic GvHD, including interleukin-2, anti‒B-cell therapy, and ibrutinib, and emerging data such as those from the phase II/III randomized trial of sirolimus plus steroid with or without a calcineurin inhibitor2
  • Evidence-based strategies for choosing the best chronic GvHD treatment for individual patients, utilizing clinical trials in this disease setting, and monitoring pulmonary status to avoid adverse manifestations
  • Current unmet needs in the treatment of chronic GvHD, such as more FDA-approved therapies, biomarkers for treatment selection, and a streamlined GvHD exam

“We are entering a new era in chronic GvHD. Our field is paying much more attention [and] recognizing, in fact, that it’s a major consequence for our patients in terms of quality of life, morbidity, and mortality. We are going to see new agents in the therapy of chronic GvHD.”
— Corey Cutler, MD, MPH

References
  1. Jagasia MH, Greinix HT, Arora M, et al. National Institutes of Health Consensus Development Project on Criteria for Clinical Trials in Chronic Graft-versus-Host Disease: I. The 2014 Diagnosis and Staging Working Group report. Biol Blood Marrow Transplant. 2015;21(3):389-401. doi: 10.1016/j.bbmt.2014.12.001.
  2. Carpenter PA, Logan BR, Lee SJ, et al; Blood and Marrow Transplant Clinical Trials Network. A phase II/III randomized, multicenter trial of prednisone/sirolimus vs prednisone/sirolimus/calcineurin inhibitor for treatment of chronic graft-versus-host disease: BMT CTN 0801. Haematologica. 2018;103(11):1915-1924. doi: 10.3324/haematol.2018.195123.

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