New therapeutic modalities in the treatment of graft-versus-host disease

Tumor necrosis factor-α blockade for the treatment of acute GVHD

“…Prednisone or methylprednisolone 1 to 2 mg/kg per day is generally accepted as the standard of care. 2,3,33 Adding other immunosuppressant drugs to steroids does not improve the treatment outcome and may increase the risk for infectious complications. Approximately 40% of patients with acute GVHD respond to corticosteroid therapy, but most patients have persistent manifestations or progressive GVHD.…”

“…It develops in approximately 30% of recipients of allogeneic blood stem cell or bone marrow transplants from human leukocyte antigen (HLA)-identical related or unrelated donors and from HLA-nonidentical related donors. [1][2][3][4][5] The pathophysiology of acute GVHD is best described as a triphasic phenomenon. 6,7 The initial phase involves the development of an inflammatory milieu resulting from damage in host tissues induced by the conditioning regimen.…”

Keratoconjunctivitis Sicca Manifestations in Ocular Graft Versus Host Disease: Pathogenesis, Presentation, Prevention, and Treatment

“…23 Importantly, many of these changes are quite comparable to in situ changes observed in other forms of dry eye, including Sjogren's syndrome-associated dry eye disease. T-cells from animal models of chronic GVHD produce a pattern of cytokines such as IL-4 and INF-ɣ in the absence of IL-12 24,25 and INF-ɣ triggers activation and differentiation of macrophages. 26 In the presence of chronic antigenic stimulation of GVHD, those macrophages most likely release the cytokines and growth factors that stimulate fibroblast proliferation and collagen production, leading to the ultimate replacement of normal ocular tissues with fibrous tissue.…”

Antithymocyte globulin for the prevention of graft-versus-host disease after unrelated hematopoietic stem cell transplantation for acute myeloid leukemia: results from the multicenter German cooperative study group

“…Criteria for diagnosis, grading and managing of acute and chronic GvHD were used as described. [15][16][17][18] For GvHD prophylaxis, 5 mg/kg cyclosporine A was given intravenously daily from day À3 to day 20 adjusted to the blood plasma level, then 6-10 mg/kg daily orally for at least 6 months. Methotrexate was also given at 15 mg/m 2 on day 1 and 10 mg/m 2 on days 3 and 6.…”