Belumosudil for the Treatment of Chronic Graft-versus-Host Disease: A Single Center Real-World Experience

Chronic graft-versus host disease (cGVHD) remains a major complication post-allogeneic stem cell transplantation (HCT). Belumosudil, a ROCK2 inhibitor was approved for cGVHD with 2–5 prior lines of therapy. We retrospectively analyzed 45 patients who received belumosudil at City of Hope Medical Center. Prior to belumosudil, the median age was 59 yrs with 3 prior lines of therapy (range 1–6). GVHD severity was predominantly moderate (37.8%) and severe (46.7%). Many patients had a prior history of ruxolitinib (71.1%), with concurrent use of belumosudil occurring in 51.1% of patients. ORR at 6-months and 12 months were 31.1% and 33.4% respectively. The best ORR at any point during belumosudil was 46.7% (CR 6.7% + PR 40%) and median FFS was 11.2 months. Infection occurred in 42% of patients, with 27% of patients requiring hospitalization to manage infection. Patients with concurrent ruxolitinib had higher infection rates (60.9% vs. 22;7%, p = 0.0156) and hospitalization (47.8% vs. 4.5%, p = 0.0017). Most infections were viral and considered mild requiring no hospitalization to manage the infection. Real-world experience with belumosudil supports the use in the treatment of cGVHD based on the ORR, promising FFS, and good tolerability in patients who have progressed on multiple prior lines of therapy.