TY - JOUR
T1 - Consensus conference on clinical practice in chronic graft-versus-host disease (GVHD)
T2 - First-line and topical treatment of chronic GVHD
AU - Wolff, Daniel
AU - Gerbitz, Armin
AU - Ayuk, Francis
AU - Kiani, Alexander
AU - Hildebrandt, Gerhard C.
AU - Vogelsang, Georgia B.
AU - Elad, Sharon
AU - Lawitschka, Anita
AU - Socie, Gerard
AU - Pavletic, Steven Z.
AU - Holler, Ernst
AU - Greinix, Hildegard
N1 - Funding Information:
The authors thank all participating centers of conferences and surveys, which included participants from the transplant centers in Augsburg, Basel, Berlin, Cologne, Dresden, Duesseldorf, Erlangen, Essen, Freiburg, Greifswald, Hamburg, Hannover, Heidelberg, Jena, Kiel, Leipzig, Linz, Mainz, Münster, Munich, Nantes, Nuernberg, Oldenburg, Paris, Regensburg, Rostock, Tuebingen, Ulm, Vienna, Wiesbaden, and Wuerzburg. The authors thank Anna Hackl for evaluating the survey on treatment of cGVHD. The conference was supported by the Jose Carreras Foundation project “Competence Center GVHD Regensburg. ”
PY - 2010/12
Y1 - 2010/12
N2 - Chronic graft-versus-host disease (cGVHD) after allogeneic hematopoietic stem cell transplantation is still associated with significant morbidity and mortality. First-line treatment of cGVHD is based on steroids of 1 mg/kg/day of prednisone. The role of calcineurin inhibitors remains controversial, especially in patients with low risk for mortality (normal platelets counts), whereas patients with low platelets at diagnosis and/or high risk for steroid toxicity may be treated upfront with the combination of prednisone and a calcineurin inhibitor. Additional systemic immunosuppressive agents, like thalidomide, mycophenolic acid, and azathioprine, failed to improve treatment results in the primary treatment of cGVHD and are in part associated with higher morbidity, and in the case of azathioprine, with higher mortality. Despite advances in diagnosis of cGVHD as well as supportive care, half of the patients fail to achieve a long-lasting response to first-line treatment, and infectious morbidity continues to be significant. Therefore, immunomodulatory interventions with low infectious morbidity and mortality such as photopheresis need urgent evaluation in clinical trials. Beside systemic immunosuppression, the use of topical immunosuppressive interventions may improve local response rates and may be used as the only treatment in mild localized organ manifestations of cGVHD.
AB - Chronic graft-versus-host disease (cGVHD) after allogeneic hematopoietic stem cell transplantation is still associated with significant morbidity and mortality. First-line treatment of cGVHD is based on steroids of 1 mg/kg/day of prednisone. The role of calcineurin inhibitors remains controversial, especially in patients with low risk for mortality (normal platelets counts), whereas patients with low platelets at diagnosis and/or high risk for steroid toxicity may be treated upfront with the combination of prednisone and a calcineurin inhibitor. Additional systemic immunosuppressive agents, like thalidomide, mycophenolic acid, and azathioprine, failed to improve treatment results in the primary treatment of cGVHD and are in part associated with higher morbidity, and in the case of azathioprine, with higher mortality. Despite advances in diagnosis of cGVHD as well as supportive care, half of the patients fail to achieve a long-lasting response to first-line treatment, and infectious morbidity continues to be significant. Therefore, immunomodulatory interventions with low infectious morbidity and mortality such as photopheresis need urgent evaluation in clinical trials. Beside systemic immunosuppression, the use of topical immunosuppressive interventions may improve local response rates and may be used as the only treatment in mild localized organ manifestations of cGVHD.
KW - Allogeneic hematopoietic stem cell transplantation
KW - Graft-versus-host disease
KW - Immunosuppressive therapy
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U2 - 10.1016/j.bbmt.2010.06.015
DO - 10.1016/j.bbmt.2010.06.015
M3 - Article
C2 - 20601036
AN - SCOPUS:77957676790
SN - 1083-8791
VL - 16
SP - 1611
EP - 1628
JO - Biology of Blood and Marrow Transplantation
JF - Biology of Blood and Marrow Transplantation
IS - 12
ER -