Adverse events in second- and third-line treatments for acute and chronic graft-<i>versus</i>-host disease: systematic review

Veličković, Vladica; McIlwaine, Emily; Zhang, Rongrong; Spelman, Tim

doi:10.1177/2040620720977039

Cited by 16 publications

(22 citation statements)

References 68 publications

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“…In attempts to control GVHD, various immunosuppressants have been used in the clinical prophylaxis and treatment of GVHD [ 11 ]. A steroid regimen remains the standard treatment, with less than 50% effectiveness [ 12 ] and no standard second-line treatment is currently available [ 13 ]. Patients with severe GVHD have dismal overall survival rates, with 25% for grade III and 5% for grade IV [ 14 ].…”

Section: Introductionmentioning

confidence: 99%

Current status of clinical trials assessing mesenchymal stem cell therapy for graft versus host disease: a systematic review

Liu

Hao

et al. 2022

Stem Cell Res Ther

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Background Graft-versus-host disease (GVHD) is a common fatal complication of hematopoietic stem cell transplantation (HSCT), where steroids are used as a treatment option. However, there are currently no second-line treatments for patients that develop steroid-resistance (SR). Mesenchymal stem cells (MSCs) have immunomodulatory functions and can exert immunosuppressive effects on the inflammatory microenvironment. A large number of in vitro experiments have confirmed that MSCs can significantly inhibit the proliferation or activation of innate and adaptive immune cells. In a mouse model of GVHD, MSCs improved weight loss and increased survival rate. Therefore, there is great promise for the clinical translation of MSCs for the prevention or treatment of GVHD, and several clinical trials have already been conducted to date. Main body In this study, we searched multiple databases and found 79 clinical trials involving the use of MSCs to prevent or treat GVHD and summarized the characteristics of these clinical trials, including study design, phase, status, and locations. We analyzed the results of these clinical trials, including the response and survival rates, to enable researchers to obtain a comprehensive understanding of the field’s progress, challenges, limitations, and future development trends. Additionally, factors that might result in inconsistencies in clinical trial results were discussed. Conclusion In this study, we attempted to analyze the clinical trials for MSCs in GVHD, identify the most suitable group of patients for MSC therapy, and provide a new perspective for the design of such trials in the future.

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Section: Introductionmentioning

confidence: 99%

Current status of clinical trials assessing mesenchymal stem cell therapy for graft versus host disease: a systematic review

Liu

Hao

et al. 2022

Stem Cell Res Ther

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“…Of all treatments for cGvHD discussed above, ECP appears to be associated with the lowest rate of infection (275).…”

Section: Infections In Association With Specific Treatment Optionsmentioning

confidence: 97%

Management of Chronic Graft-vs.-Host Disease in Children and Adolescents With ALL: Present Status and Model for a Personalised Management Plan

Sobkowiak-Sobierajska

Lindemans

Sýkora

et al. 2022

Front. Pediatr.

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Herein we review current practice regarding the management of chronic graft-vs.-host disease (cGvHD) in paediatric patients after allogeneic haematopoietic stem cell transplantation (HSCT) for acute lymphoblastic leukaemia (ALL). Topics covered include: (i) the epidemiology of cGvHD; (ii) an overview of advances in our understanding cGvHD pathogenesis; (iii) current knowledge regarding risk factors for cGvHD and prevention strategies complemented by biomarkers; (iii) the paediatric aspects of the 2014 National Institutes for Health-defined diagnosis and grading of cGvHD; and (iv) current options for cGvHD treatment. We cover topical therapy and newly approved tyrosine kinase inhibitors, emphasising the use of immunomodulatory approaches in the context of the delicate counterbalance between immunosuppression and immune reconstitution as well as risks of relapse and infectious complications. We examine real-world approaches of response assessment and tapering schedules of treatment. Furthermore, we report on the optimal timepoints for therapeutic interventions and changes in relation to immune reconstitution and risk of relapse/infection. Additionally, we review the different options for anti-infectious prophylaxis. Finally, we put forth a theory of a holistic view of paediatric cGvHD and its associated manifestations and propose a checklist for individualised risk evaluation with aggregated considerations including site-specific cGvHD evaluation with attention to each individual's GvHD history, previous medical history, comorbidities, and personal tolerance and psychosocial circumstances. To complement this checklist, we present a treatment algorithm using representative patients to inform the personalised management plans for patients with cGvHD after HSCT for ALL who are at high risk of relapse.

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“…Notably, a recent systematic review of adverse events in second-and third-line treatments for acute and chronic GvHD revealed a lower incidence of infectious adverse events in acute GvHD and lower number of grade 3-5 adverse events in cGvHD in patients on ECP compared to any pharmaceutical management highlighting the safety aspect of this form of treatment (36).…”

Section: Chronic Gvhdmentioning

confidence: 99%

Established and Emerging Treatments of Skin GvHD

2022

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Graft-versus-host disease (GvHD) of the skin is a severe allo-immune reaction and complication following allogeneic stem cell transplantation. Over the past years, intensive pre-clinical research has led to an improved understanding of the pathophysiology of acute and to a lesser extend chronic GvHD. This has translated into the approval of several new agents for the treatment of both forms of GvHD. This review summarizes the most recent advances in underlying pathomechanisms, clinical trials and newly approved agents for GvHD, with a special focus on skin involvement.

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Adverse events in second- and third-line treatments for acute and chronic graft-versus-host disease: systematic review

Cited by 16 publications

References 68 publications

Current status of clinical trials assessing mesenchymal stem cell therapy for graft versus host disease: a systematic review

Current status of clinical trials assessing mesenchymal stem cell therapy for graft versus host disease: a systematic review

Management of Chronic Graft-vs.-Host Disease in Children and Adolescents With ALL: Present Status and Model for a Personalised Management Plan

Established and Emerging Treatments of Skin GvHD

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