Real-world data in chronic graft-versus-host disease (cGVHD) are crucial to provide insights into treatment effectiveness in everyday clinical settings. Data from real-world studies also highlight unmet treatment needs, contributing to better management and quality of life for patients with cGVHD.

I think that the most important thing to know about real-world studies in cGVHD is that the majority of those evaluating belumosudil and ruxolitinib affirm the results that we saw in pivotal clinical trials. It is a rare example of the real-world evidence very closely mirroring the clinical trial experience. Patients who are treated in the real world are not necessarily ideal candidates for treatment, like those who are enrolled in clinical trials, so I think that this is a testament to the activity of these compounds.

Additive therapy with belumosudil and ruxolitinib has been explored at my institution and elsewhere in patients with cGVHD with an inadequate response to monotherapy. In fact, at my institution, we have about 35 patients who have received additive therapy. I think that it is very difficult to talk about the response rate in these patients because they are not being followed formally on clinical trials, and National Institutes of Health (NIH) assessment for cGVHD is not always being performed in a prospective manner. However, we can say that the combination of these 2 drugs seems safe when they are given together, as they have very different sets of side effects.

Current patients with cGVHD are fortunate in that they have access to all these newer therapeutics. I think with fewer patients developing cGVHD and our push to use more effective therapeutics earlier after diagnosis, looking ahead, we are probably going to see a change in the overall landscape of cGVHD.

Finally, we are learning that there are differences in transplant outcomes based on donor age. In general, younger donors are preferable to older donors, as there is a reduced risk of adverse outcomes such as cGVHD. However, it is very hard to say whether choosing a 40-year-old sibling donor or a 25-year-old unrelated donor would be preferable. We are not at the point where we can make a definitive call when comparing 2 donors such as these, but we do understand that younger donors are better, particularly as methodology in human leukocyte antigen (HLA) matching makes unrelated donors almost equivalent to HLA-matched siblings.