Bhatt, Neel S.; Harris, Andrew C.; Gorfinkel, Lev; Ibanez, Katarzyna; Tkaczyk, Eric R.; Mitchell, Sandra A.; Albuquerque, Stacey; Schechter, Tal; Pavletic, Steven; Duncan, Christine N.; Rotz, Seth J.; Williams, Kirsten; Carpenter, Paul A.; Cuvelier, Geoffrey D.E. “Pediatric Transplant and Cellular Therapy Consortium RESILIENT Conference on Pediatric Chronic Graft-Versus-Host Disease Survivorship After Hematopoietic Cell Transplantation: Part I. Phases of Chronic GVHD, Supportive Care, and Systemic Therapy Discontinuation.” Transplantation and Cellular Therapy, 2025, https://doi.org/10.1016/j.jtct.2024.12.011.
Chronic graft-versus-host disease (cGVHD) is a major complication that can occur after children and adolescents undergo hematopoietic cell transplantation (HCT), a treatment for certain cancers and blood disorders. However, there is limited information on how cGVHD affects long-term survival and quality of life in pediatric patients. This is an important issue since children who receive HCT have a longer life expectancy compared to adults. To address this gap in knowledge, experts in pediatric cGVHD and late effects of HCT formed a group called RESILIENT, which stands for Research and Education towards Solutions for Late effects to Innovate, Excel, and Nurture after cGVHD. The group aimed to better understand how cGVHD affects children after transplant, improve care for long-term survivors, and develop a research plan for the future.
The task force split into four working groups, each focusing on a specific area: (1) understanding the stages of cGVHD and how it affects the ability to safely reduce or stop treatment, (2) organ damage and immune system recovery, (3) how cGVHD and its treatments impact growth and development, and (4) the psychological health of patients. These groups met in advance of a large medical conference to discuss their findings and seek feedback. The first manuscript from the group focuses on the challenges clinicians face when trying to determine when to stop or reduce the treatment for cGVHD. One major issue is distinguishing between active cGVHD (which needs treatment) and quiescent cGVHD (which is less active and might not need treatment). To address these challenges, the group recommends new ways to categorize long-term outcomes of cGVHD and offers practical guidance for clinicians on how to monitor and manage these patients over the long term, including when to adjust treatment and how to use supportive care.
Figure 1. The long-term goal of pediatric allogeneic HCT is to achieve not only disease eradication but also normal organ function, optimal growth and development, improve functional status, lessen symptom burden and promote high quality of life. Chronic GVHD can be a significant barrier to these goals. The RESILIENT consortium examines various aspects of chronic GVHD and long-term survivorship to achieve resilience for infants, children, and adolescents requiring allogeneic HCT.
