Chronic graft-versus-host disease: is there an alternative to the conventional treatment?

Gaziev, D; Galimberti, M; Lucarelli, G; Polchi, P

doi:10.1038/sj.bmt.1702235

Cited by 36 publications

(13 citation statements)

References 65 publications

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“…38 Since two of our cases died of progressive chronic GVHD after the tapering off of immunosuppressive agents, careful attentions should be paid to the occurrence or progression of chronic GVHD after the reduction of immunosuppressants. An exact effect of the reduction of immunosuppressants for the treatment of TMA should be determined in a prospective study with a substantially larger number of subjects.…”

Section: Discussionmentioning

confidence: 99%

Intestinal thrombotic microangiopathy after allogeneic bone marrow transplantation: a clinical imitator of acute enteric graft-versus-host disease

Nishida

Hamaguchi

Hirabayashi³

et al. 2004

Bone Marrow Transplant

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Summary:Thrombotic microangiopathy after bone marrow transplantation (post-BMT TMA) is a serious transplantrelated complication. We identified 16 patients with TMA after allogeneic BMT who showed histopathological evidence of intestinal TMA in their gut specimens (six autopsies, 10 biopsies). In all, 14 patients had grade II-IV acute graft-versus-host disease (GVHD). The first seven patients were retrospectively diagnosed with TMA. Since six of them were diagnosed with progressive GVHD at that time because there was no awareness of the existence of intestinal TMA, they received more intensive treatment for GVHD, but all died between days þ 49 and þ 253. In contrast, the remaining nine patients were recently diagnosed with intestinal TMA on the basis of colonoscopic biopsies. For eight of these patients, the immunosuppressants were reduced, and the patients' intestinal symptoms improved gradually. Six of the nine patients were still alive 12 months after the diagnosis of TMA. Our findings suggest that the gut may be a site involved in post-BMT TMA, presenting as ischemic enterocolitis. Differentiating intestinal TMA from acute GVHD is important in patients suffering from severe and refractory diarrhea after BMT.

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Section: Discussionmentioning

confidence: 99%

Intestinal thrombotic microangiopathy after allogeneic bone marrow transplantation: a clinical imitator of acute enteric graft-versus-host disease

Nishida

Hamaguchi

Hirabayashi³

et al. 2004

Bone Marrow Transplant

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“…However, it is difficult to define the role of these agents as first line therapy for cGVHD without conventional immunosuppressive drugs. 11 Many drugs used in the past are returning to the forefront for investigation. To our knowledge, there are no published data on treatment results in cGVHD using a three or more conventional drug combination, particularly in pediatric patients.…”

Section: Discussionmentioning

confidence: 99%

“…Over the past decade attempts to improve survival have led to the evaluation of alternative approaches for treatment of cGVHD with varying degrees of success. 11 However, it is difficult to define the role of these alternative therapies in the treatment of cGVHD as they were mostly given as salvage therapy along with conventional immunosuppressive medications. Clinical trials must be performed earlier in the course of the disease to establish the role of these drugs in the treatment of cGVHD.…”

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confidence: 99%

A three or more drug combination as effective therapy for moderate or severe chronic graft-versus-host disease

Gaziev¹,

Lucarelli²,

Polchi³

et al. 2001

Bone Marrow Transplant

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Summary:We analyzed the results of a three or more drug combination as treatment for moderate or severe cGVHD developing after transplantation for thalassemia, in 45 patients with median age of 11 (range 2-26) years. Eighteen patients received a three drug regimen with cyclosporine (CsA), methylprednisolone (MP) and azathioprine (AZ) as first line therapy, 16 patients received this regimen as salvage therapy and 11 patients were given a four or five drug regimen with CsA, MP, AZ, cyclophosphamide (CY) and/or methotrexate (MTX) mainly as salvage therapy. The overall complete response (CR) rate was 77.3%, with 94% of CR in patients receiving the three drug regimen as first line, 88% in patients receiving it as salvage therapy and 36.6% in patients given the four or five drug regimen. The probability of CR in patients given the three drug regimen as first or salvage therapy or the four/five drug regimen was 89%, 53% and 30%, while the probability of survival was 89%, 65% and 58%, respectively. The incidence of treatment failure was low in our patients. Patients treated with the three drug regimen as first line therapy had less treatment-related complications than patients receiving this regimen as salvage therapy or patients given the four or five drug regimen. The main causes of treatment-related mortality (20%) were infectious complications. This retrospective study showed that a three or more drug combination is safe and effective for treatment of moderate or severe cGVHD at least in younger patients. Bone Marrow Transplantation (2001) 27, 45-51. Keywords: chronic graft-versus-host disease; bone marrow transplantation; thalassemia; multiagent immunosuppressive treatment Chronic graft-versus-host disease (cGVHD) is the most common late complication of allogeneic hematopoietic stem cell transplantation and its associated immunodeficiency and infection are major causes of morbidity and mortality following transplant. With the increasing number of allogeneic matched, mismatched and unrelated bone

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“…3,4 Recognized treatments for cGVHD utilize agents used in the treatment of autoimmune disorders and are associated with response rates of 20% to 80%, but may cause significant toxicity. 5,6 Phototherapy has also been used experimentally and clinically to modify GVHD. Antigen-presenting cells and T lymphocytes are susceptible to photoinactivation with either ultraviolet B irradiation or ultraviolet A irradiation (UVA) in the presence of a photosensitizing agent such as 8-methoxypsoralen (8-MOP).…”

Section: Introductionmentioning

confidence: 99%

Influence of extracorporeal photopheresis on clinical and laboratory parameters in chronic graft-versus-host disease and analysis of predictors of response

Seaton

Szydlo

Kanfer

et al. 2003

Blood

105

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We report 28 patients with advanced chronic graft-versus-host disease (cGVHD) treated with extracorporeal photopheresis (ECP). All had failed conventional immunosuppressive therapy. Of the patients, 27 had extensive cGVHD and 20 had more than 50% cutaneous surface area involvement. ECP was initiated approximately 2 years after onset of cGVHD and 3 years following allogeneic stem cell transplantation and administered fortnightly for 4 months and then monthly. Response was assessed using quantifiable disease measures, including skin score, liver function tests (LFTs), blood counts, and lung function tests. Regression analysis allowed assessment of any pretreatment clinical or laboratory parameters that predicted response. There were 25 patients who completed 3 months and 21 who completed 6 months of treatment. Systemic immunosuppression was stable or reduced in 86% of patients. There were 3 patients who died from cGVHD. After 6 months, median skin scores were 53% lower (P ‫؍‬ .003) in sclerodermoid and lichenoid disease. Of 6 patients with mucosal ulceration, 3 im-

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Chronic graft-versus-host disease: is there an alternative to the conventional treatment?

Abstract: Summary:Despite conventional and new therapies for the treatment of chronic GVHD (cGVHD), this syndrome continues to account for significant morbidity and mortality after allogeneic hematopoietic stem cell transplantation.

Cited by 36 publications

References 65 publications

Intestinal thrombotic microangiopathy after allogeneic bone marrow transplantation: a clinical imitator of acute enteric graft-versus-host disease

Intestinal thrombotic microangiopathy after allogeneic bone marrow transplantation: a clinical imitator of acute enteric graft-versus-host disease

A three or more drug combination as effective therapy for moderate or severe chronic graft-versus-host disease

Influence of extracorporeal photopheresis on clinical and laboratory parameters in chronic graft-versus-host disease and analysis of predictors of response

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