Acute graft‐versus‐host disease: Pathophysiology, clinical manifestations, and management

Treatment of steroid-resistant acute GVHD with OKT3 and high-dose steroids results in better disease control and lower incidence of infectious complications when compared to high-dose steroids alone: a randomized multicenter trial by the EBMT Chronic Leukemia Working Party

“…7 Taking into account also the latter publication, a large number of investigations demonstrated two facts: first, a lack of consensus on the choice of second-line treatment and, second, considerably high mortality rates. 3,8 We observed a higher overall response rate on study day 100 with OKT3 and high-dose corticosteroids than with steroids alone (53 vs 33%; P ¼ 0.06) despite a higher proportion of patients with a more favorable risk profile in the steroid cohort. Similarly, survival probability of patients with severe GVHD (1III and 1IV) by study day 100 was increased from 31 to 57% and was more than doubled at 1 year from allogeneic transplant (45 vs 21%; P ¼ 0.061) but with small absolute numbers of subjects.…”

“…Familial cases indicated as unlikely the action of an oncosuppressor gene in the pathogenesis of MDS/AML associated with monosomy 7, 1 and its role is thought to be mediated by gene dosage effects, recently investigated by microarray analysis. 2 The presence of monosomy 7 portends a poor clinical outcome, both in MDS 3 and in AML, 4 and hence the clinical relevance of accurate monitoring of the abnormal clone during the course of the disease. We present here data concerning the methods to monitor the consistency of the monosomic clone and the parental origin of the chromosome 7 loss.…”

“…Methylprednisolone (MP) 2 mg/kg body weight is generally used as an initial treatment; however, achievement of durable response to steroids widely varies with both the extent of human leukocyte antigen (HLA) disparity between donor and recipient and disease severity. [1][2][3] Failure of adequate response to MP represents refractory GVHD that is difficult to manage. Numerous approaches and agents have, often retrospectively, been evaluated.…”

Stem cells; mesenchymal stem cells and current clinical applications

“…Literatüre göre steroidlere dirençli GVHD olgularında sa¤kalım oranı %10 ve altındadır. [28,29] Multipotent progenitor hücreler olan MKH'ler ekstansif immünmodulatör etkilerinden dolayı GVHD'de kullanılmaktadır. Mezenkimal kök hüc-renin GVHD'de kullanımının ilk baarılı denemesi 2004 yılında LeBlanck ve ark.…”

Potential role of mesenchymal stromal cells in pediatric hematopoietic SCT

“…Despite advances in donor HLA typing methods (and thus donor selection) and post-transplant immune suppression, acute (a)GvHD remains a significant cause of TRM and morbidity following allogeneic HSCT, even in the matched HLAidentical sibling setting. 58 Steroids still represent first-line treatment for established GVHD with a response rate in the order of 30-50%, whereas the outcome of patients with severe steroid-refractory aGVHD remains unsatisfactory and overall survival is poor. 59 Le Blanc et al 60 reported the successful treatment of severe steroid/treatment-resistant grade IV aGVHD of the gut and liver in a nine-year-old with haploidentical third party BM-derived MSCs.…”