Table 6.
Features of Ideal Preemptive Therapeutic Agents
Feature | Considerations |
---|---|
Biological rationale | - Selection of interventions that target pathways implicated in chronic GVHD pathogenesis |
Safety | - Low toxicity, limited interactions with medications given after HCT |
- Risk profile of intervention commensurate with severity of outcome to be prevented (and PPV of the assessment/biomarker) | |
- When possible, minimize disruption of graft-versus-malignancy effects | |
Tolerability/cost | - Ensure intervention adherence |
- Allow prolonged therapy to prevent late occurring chronic GVHD events | |
- Patient and health care system able to afford treatment | |
Efficacy | - Prioritization of agents with demonstrated activity in chronic GVHD therapy or allied human immune-mediated disorders |
Transportability | - Logistics of delivering therapy permit dissemination |
- Orally available agents generally preferred |