Corticosteroid regimens for treatment of acute and chronic graft versus host disease (GvHD) after allogenic stem cell transplantation

Salmasian, Hojjat; Rohanizadegan, Mersedeh; Banihosseini, Setareh Sadat; Darabad, Raheleh Rahimi; Rabbani‐Anari, Mahtab; Shakiba, Alia; Ferrara, James L.M.

doi:10.1002/14651858.cd005565.pub2

Cited by 27 publications

(24 citation statements)

References 19 publications

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“…Typically, methylprednisolone 2 mg/kg per day is used in divided doses for several weeks, followed by a gradual taper. Opportunistic infections and interstitial pneumonitis may occur [31]. For patients with GvHD with gastrointestinal involvement without infection, budesonide or beclomethasone may allow reduction of systemic steroids.…”

Section: Graft-versus-host Diseasementioning

confidence: 99%

Glucocorticoid therapy for gastrointestinal diseases

Triadafilopoulos¹

2014

Expert Opinion on Drug Safety

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Long-term cohort studies as well as placebo- and sham-controlled trials have evaluated the clinical efficacy, safety and tolerability of glucocorticoid therapy in many gastrointestinal diseases. Other immunosuppressive and biological therapies have made glucocorticoid therapy part of a broader arsenal of therapies. Newer compounds that carry less systemic toxicity and improved tolerability are increasingly used. For several gastrointestinal diseases, the role of the mucosal immunity is currently being explored and microscopic inflammation of the intestinal mucosa may have an important pathogenetic role. Glucocorticoid therapy, particularly with newer, safer compounds, may play an important new role in patients with altered motility and visceral hypersensitivity. The interplay of the gut microbiota and the host that contributes to the development of gut-associated lymphoid tissues and gut-specific immune responses will also undoubtedly be explored.

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Section: Graft-versus-host Diseasementioning

confidence: 99%

Glucocorticoid therapy for gastrointestinal diseases

Triadafilopoulos¹

2014

Expert Opinion on Drug Safety

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“…Unfortunately, only two, poor quality acute GVHD trials met the revised inclusion criteria and a meta-analysis could not be carried out owing to differences in the clinical question being addressed. 38 Hence, the impact of corticosteroids upon survival in cGVHD remains unknown and their effect on quality of life could not be evaluated because of lack of evidence. Obtaining this information is of importance because of the side effect profile of corticosteroids and to find answers to questions regarding optimal duration of treatment and tapering regimens.…”

Section: Extensive Diseasementioning

confidence: 99%

More than skin deep? Emerging therapies for chronic cutaneous GVHD

Rodgers

Burge

Scarisbrick

et al. 2012

Bone Marrow Transplant

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The options for treating skin disease after haemopoietic progenitor cell transplant (HPCT) have broadened considerably over the last decade to include much more than topical steroids and emollients. This article reviews current and emerging therapies for chronic cutaneous GVHD, a well-recognised complication of HPCT. Alongside skin-directed therapies, there is now a wide range of systemic agents with differing targets for which an evidence base is emerging. Of particular interest, we summarise the role of electrocorporeal photopheresis, a therapy increasingly used in the United Kingdom to treat severe sclerodermoid manifestations of GVHD. We include a discussion of the expanding knowledge of the pathogenesis of cutaneous GVHD, which is informing our understanding and development of second line therapies (for example, the role of B cells and the utility of rituximab). Additionally, we draw attention to challenges encountered in the evaluation of chronic GVHD treatments and highlight recommendations for further research that may enable haematologists and dermatologists to provide better care for these patients. Finally, we present a clinical algorithm to aid the approach to treating limited and extensive disease and steroid refractory or persistent disease where steroid sparing may be necessary.

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“…4 Systemic immunosuppressive therapy (IST) remains the standard approach for the treatment of GVHD, the duration of which can be prolonged particularly in chronic GVHD (cGVHD), which occurs in ~50% of patients. 5,6 Corticosteroids remain the standard first-line IST for GVHD. [7][8][9] This pharmacological approach is effective only in ~50% of patients; 10 moreover, its use is limited by toxicity.…”

Section: Introductionmentioning

confidence: 99%

An update on the clinical utility of extracorporeal photopheresis in the treatment of graft-versus-host disease

Salem¹,

Webb²,

Jacobsohn³

2017

IJCTM

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Graft-versus-host disease (GVHD) continues to be a major complication following allogeneic hematopoietic cell transplantation (allo-HCT) with high morbidity and mortality. Corticosteroids are the first-line treatment for GVHD; however, a substantial number of patients go on to require second-line treatment where no single therapeutic modality has been proven to be the most effective. Extracorporeal photopheresis (ECP) is an efficient and established therapy for cutaneous T-cell lymphoma, GVHD, rejection after solid organ transplantation and various autoimmune diseases. Although large randomized trials are limited, there is compelling cumulative data on the efficacy of ECP for GVHD, and the response rates, especially for cutaneous involvement, are encouraging. ECP has an excellent safety profile, a well-documented steroid-sparing effect, proven survival benefit and overall quality-of-life improvement. In many institutions, ECP is commonly regarded as the preferred second-line treatment for GVHD.

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Corticosteroid regimens for treatment of acute and chronic graft versus host disease (GvHD) after allogenic stem cell transplantation

Cited by 27 publications

References 19 publications

Glucocorticoid therapy for gastrointestinal diseases

Glucocorticoid therapy for gastrointestinal diseases

More than skin deep? Emerging therapies for chronic cutaneous GVHD

An update on the clinical utility of extracorporeal photopheresis in the treatment of graft-versus-host disease

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