The clinical landscape of chronic graft‐versus‐host disease management in 2021

Abstract

Chronic graft-versus-host disease (cGVHD) is an important systemic complication of allogeneic haematopoietic stem cell transplantation with heterogeneous, multi-organ involvement that can lead to increased morbidity and mortality. Despite significant advances in understanding the complex pathophysiology driving the disease, curative treatment options remain suboptimal. The past decade, however, has seen much growth in collaborative research efforts and standardization of criteria for clinical trials that have led to discovery of several new second-line therapies in cGVHD. The key to successful cGVHD control and management includes a comprehensive and sustained multidisciplinary effort with emphasis on ancillary and supportive care for these patients. The focus of this review is to summarize the new developments in systemic, organ-specific, and topical treatments in the management of cGVHD that emerged since the 2014 NIH consensus conference.

Rapamycin Treatment Alleviates Chronic GVHD-Induced Lupus Nephritis in Mice by Recovering IL-2 Production and Regulatory T Cells While Inhibiting Effector T Cells Activation

“…These include two main types of GVHD: acute and chronic [ 24 ]. The typical characteristics of acute GVHD are gastrointestinal ulcer, liver dysfunction and erythematous skin injury, while the clinical manifestations of chronic GVHD are usually similar to autoimmune diseases such as systemic lupus erythematosus, Sjogren’s syndrome, scleroderma and rheumatoid arthritis [ 25 , 26 ]. cGVHD is the most serious, and is an increasingly common long-term complication of allogeneic stem cell transplantation (alloSCT), affecting up to 80% of patients in some series [ 27 ].…”

Dynamic forecasting module for chronic graft-versus-host disease progression based on a disease-specific subpopulation of B cells

“…This leads to a lag in cGVHD therapeutic strategy and necessitates an trial-and-error approach for subsequent treatments 13 . Usually, the therapeutic response should be assessed at 8-12 weeks as it is reported that most therapies take some time to reach therapeutic peak 14 . If a patient exhibits progression of cGVHD after being on a given treatment for 4 or more weeks, a new treatment option should be offered 15,16 .…”

“…Usually, the therapeutic response should be assessed at 8-12 weeks as it is reported that most therapies take some time to reach therapeutic peak 14 . If a patient exhibits progression of cGVHD after being on a given treatment for 4 or more weeks, a new treatment option should be offered 15,16 . Many patients may fail to engage with a given treatment for enough time to fully assess its e cacy (at least 4 weeks), limiting the ability of clinicians to identify an effective treatment for each patient 17 .…”

Results of an Innovative Program for Surveillance, Prophylaxis, and Treatment of Infectious Complications Following Allogeneic Stem Cell Transplantation in Hematological Malignancies (BATMO Protocol)

“…Bacterial, fungal, and viral infections frequently complicate the clinical course of allogeneic stem cell transplantation (Allo-SCT) (1). The time at which infections occur after transplantation depends on several factors, the most significant of which are the degree and duration of neutropenia and the severity of immunosuppression (2). Overall, infectious complications may occur up to one year following allo-SCT, and this time period becomes longer in case of chronic graft versus host disease (cGVHD) (1,2).…”