One has FDA approval for paediatric SR-aGvHD, which is estimated...

One has FDA approval for paediatric SR-aGvHD, which is estimated to be approximately 15% of the adult SR-aGvHD market. Then, said company (for clarity, Mesoblast), wants a label extension to a third-line treatment for adult SR-aGvHD. Cynata, on the other hand, are targeting High-Risk aGvHD. The difference in market size between what Mesoblast and Cynata are targeting is stark.

To contextualise this, you need to understand that:

1. Approximately 50% of patients who develop aGvHD do not respond to steroids and become ‘steroid resistant’.
2. Approximately 15% of patients who are SR do not respond to Ruxolitinib.

This means that of the full pie of approximately 5000 adults who contract aGvHD each year, Mesoblast’s market is a measly 7.5% (375). The paediatric market adds approximately another 375 patients/year, so you end up with a total market of 750 patients/year available to treat.

Cynata, on the other hand, are targeting High-Risk aGvHD adults. Assuming the High Risk assessment criteria (MAGIC) is perfect, the minimum market size is 2500 adult patients/year. So 3.3x the market size Mesoblast is targeting.

$50M vs $4000M. I am comfortable that I am positioned for the Risk/Reward correctly here. By the end of 2026 we will definitely know for sure, possibly even by mid 2026 when both the GvHD and knee OA trials have read out. Time will tell.