Severe Chronic Pulmonary Graft Versus Host Disease: Case Report

Postolache, Paraschiva; Niţu, Floarea Mimi; Olteanu, Mihai; Olteanu, Mădălina; Golli, Andreea Loredana; Călărașu, Cristina

doi:10.1378/chest.2281064

Cited by 1 publication

(2 citation statements)

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“…Another possible alternative would have been extracorporeal photopheresis, which has been reported with some success in the treatment of GVHD in several studies with response rates up to 40 and 67% for restrictive and obstructive lung involvement. 2 Nevertheless, this option was discarded because of the patient's compromised clinical situation and the need of several cycles to obtain any response. On the other hand, the use of etanercept for the treatment of refractory cases of GVHD has shown response rates between 46-62% and a favorable safety profile in some studies.…”

Section: Discussionmentioning

confidence: 99%

“…Acute GVHD (aGVHD) is the main complication during the first months after transplantation and can affect many organ systems including the skin, gastrointestinal tract, liver, and, less frequently other organs including lungs. 2 The impact of GVHD, especially refractory GVHD on morbidity and mortality, in addition to other common complications of allo-HSCT, highlights the importance of individualizing the treatment, seeking the best possible benefit-risk balance. 1…”

Section: Introductionmentioning

confidence: 99%

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Tocilizumab as salvage treatment of refractory pulmonary acute graft-versus-host disease

Melgarejo-Ortuño

Escudero‐Vilaplana

Revuelta-Herrero

et al. 2020

J Oncol Pharm Pract

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Introduction Acute graft-versus-host disease GVHD (aGVHD) is the main complication during the first months after bone transplantation. Steroid therapy is clearly the upfront established treatment for aGVHD. However, there are patients with partial response to steroid treatment and steroid-refractory cases. For those patients, a vast number of therapeutic options have emerged, although the evidence is scarce. Case report We report the use of tocilizumab as salvage treatment in a patient with corticosteroid refractory pulmonary aGVHD that was admitted to the critical care unit for respiratory support measures. Management & outcome We decided to use tocilizumab as rescue treatment, after failure of corticosteroid treatment, standard treatment with broad-spectrum antibiotics and etanercept. The patient showed a remarkable clinical improvement two days after first infusion and a total resolution of the symptomatology with normalization of the spirometry tests after 4 weeks of the administration of tocilizumab. Discussion To the authors' knowledge, this is the first case that describes the effective and safe use of tocilizumab as a rescue treatment in a patient with steroid-refractory pulmonary aGVHD. It showed a rapid onset of action and a favorable safety profile, which could make it an interesting option for the treatment of this potentially fatal complication.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%