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Acute graft-versus-host disease: newer treatment strategies

Jan 24, 2019

Acute graft-versus-host disease (GvHD) remains a serious complication after allogeneic hematopoietic stem cell transplantation (allo-HSCT). To date, corticosteroids are the accepted first-line therapy, however are only effective in approximately half of all patients with ~50% of cases going on to develop steroid-refractory GvHD, which leads to increased non-relapse mortality rates. Thus, there is an unmet need for development of novel treatment strategies for acute GvHD to improve post-transplant outcomes. Please see the current novel therapy options in the downloadable table below:

  1. Hill L. et al. New and emerging therapies for acute and chronic graft versus host disease. Ther Adv Hematol. 2018 Jan;9(1):21-46. DOI: 10.1177/2040620717741860. Epub 2017 Nov 28.
  2. Malard F.  et al. Continuous reduced non-relapse mortality after allogeneic hematopoietic stem cell transplantation: a single-institution's three decade experience. Biol Blood Marrow Transplant. 2014 August. DOI: 10.1016/j.bbmt.2014.04.021. Epub 2014 Apr 23.
  3. Storb R.  et al. Methotrexatee and cyclosporine compared with cyclosporine alone for prophylaxis of acute graft versus host disease after marrow transplantation for leukemia. N Engl J Med. 1986 Mar 20;314(12):729–35.
  4. Storb R.  et al. Methotrexatee and cyclosporine versus cyclosporine alone for prophylaxis of graft-versus-host disease in patients given HLA-identical marrow grafts for leukemia: long-term follow-up of a controlled trial. Blood. 1989 May 1;73(6):1729–34.
  5. Kumar A.  et al. Antithymocyte globulin for acute-graft-versus-host-disease prophylaxis in patients undergoing allogeneic hematopoietic cell transplantation: a systematic review. Leukemia. 2012 Apr;26(4):582–8. DOI: 10.1038/leu.2011.349. Epub 2011 Dec 20.
  6. Finke J.  et al. Standard graft-versus-host disease prophylaxis with or without anti-T-cell globulin in haematopoietic cell transplantation from matched unrelated donors: a randomised, open-label, multicentre phase 3 trial. Lancet Oncol. 2009 Sep;10(9):855–64. DOI: 10.1016/S1470-2045(09)70225-6. Epub 2009 Aug 18.
  7. Van Lint MT.  et al. Early treatment of acute graft-versus-host disease with high- or low-dose 6-methylprednisolonenisolone: A multicenter randomized trial from the Italian group for bone marrow transplantation. Blood. 1998;92:2288–93.
  8. Mielcarek M.  et al. Initial therapy of acute graft-versus-host disease with low-dose prednisolonenisone does not compromise patient outcomes. Blood. 2009 Mar 26;113(13):2888–94. DOI: 10.1182/blood-2008-07-168401. Epub 2008 Nov 10.
  9. Mielcarek M.  et al. Effectiveness and safety of lower dose prednisolonenisone for initial treatment of acute graft-versus-host disease: a randomized controlled trial. Haematologica. 2015 Jun;100(6):842–8. DOI: 10.3324/haematol.2014.118471. Epub 2015 Feb 14.
  10. Alousi AM.  et al. Etanercept, mycophenolate, denileukin, or pentostatin plus corticosteroids for acute graft-versus-host disease: a randomized phase 2 trial from the Blood and Marrow Transplant Clinical Trials Network. Blood. 2009 Jul 16;114(3):511–7. DOI: 10.1182/blood-2009-03-212290. Epub 2009 May 14.
  11. Bolaños-Meade J.  et al. Phase 3 clinical trial of steroids/mycophenolate mofetil vs steroids/placebo as therapy for acute GVHD: BMT CTN 0802. Blood. 2014 Nov 20;124(22):3221–7; quiz 3335. DOI: 10.1182/blood-2014-06-577023. Epub 2014 Aug 28.
  12. Zeiser R.  et al. Ruxolitinib in corticosteroid-refractory graft-versus-host disease after allogeneic stem cell transplantation: a multicenter survey. Leukemia. 2015 Oct;29(10):2062–8. DOI: 10.1038/leu.2015.212. Epub 2015 Jul.