Steroid-Refractory aGVHD Is a Major Threat to Transplant Outcomes
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Graft-versus-host disease (GVHD) is a potentially life-threatening complication of allogeneic hematopoietic stem cell transplant (allo-HSCT) driven by alloreactive donor T cells.2
GVHD remains a major cause of morbidity and nonrelapse mortality for allo-HSCT recipients.3,4
There is distinct pathophysiology and presentation of acute GVHD and chronic GVHD. Acute GVHD can occur at any time, but often occurs in the first few months after transplant.5
Acute GVHD is characterized by inflammatory response driven by alloreactive donor T cells and may affect the skin, gastrointestinal tract, and liver.5-8
Diagnosis and Management of Acute GVHD
Diagnosis is based on clinical signs and symptoms as well as biopsies and laboratory tests.9 Grading and staging of aGVHD may help assess severity and guide disease management.8,11
The standard of care for initial aGVHD therapy is daily systemic steroids.11-15
However, approximately half of patients with aGVHD will not achieve an adequate response to steroids.11-15 These patients with an incomplete initial response may have steroid-refractory aGVHD, and require additional therapy.11-15
Identify patients with steroid-refractory aGVHD. LEARN MORE.
- Jakafi Prescribing Information. Wilmington, DE: Incyte Corporation.
- McDonald-Hyman C, Turka LA, Blazar BR. Advances and challenges in immunotherapy for solid organ and bone marrow transplantation. Sci Transl Med. 2015;7:280rv2. doi: 10.1126/scitranslmed.aaa6853.
- Garnett C, Apperley JF, Pavlů J. Treatment and management of graft-versus-host disease: improving response and survival. Ther Adv Hematol. 2013;4(6):366-378.
- Renteria AS, Levine JE, Ferrara JL. Development of a biomarker scoring system for use in graft-versus-host disease. Biomark Med. 2016;10(8):793-795.
- Filipovich AH, Weisdorf D, Pavletic S, et al. National Institutes of Health consensus development project on criteria for clinical trials in chronic graft-versus-host disease: I. Diagnosis and Staging Working Group report. Biol Blood Marrow Transplant. 2005;11(12):945-956.
- Blazar BR, Murphy WJ, Abedi M. Advances in graft-versus-host disease biology and therapy. Nat Rev Immunol. 2012;12(6):443-458.
- Pierini A, Alvarez M, Negrin RS. NK cell and CD4+FoxP3+ regulatory T cell based therapies for hematopoietic stem cell engraftment. Stem Cells Int. 2016;2016:9025835. doi:10.1155/2016/9025835.
- Nassereddine S, Rafei H, Elbahesh E, et al. Acute graft versus host disease: a comprehensive review. Anticancer Res. 2017;37(4):1547-1555.
- Pavletic SZ, Fowler DH. Are we making progress in GVHD prophylaxis and treatment? Hematology. 2012;2012:251-264.
- Ferrara J, Levine JE, Reddy P, et al. Graft-versus-host disease. Lancet. 2009;373(9674):1550-1561.
- Martin PJ, Rizzo JD, Wingard JR, et al. First- and second-line systemic treatment of acute graft-versus-host disease: recommendations of the American Society of Blood and Marrow Transplantation. Biol Blood Marrow Transplant. 2012;18(8):1150-1163.
- Dignan FL, Clark A, Amrolia P, et al. Diagnosis and management of acute graft-versus-host disease. Br J Haematol. 2012;158(1):30-45.
- MacMillan ML, Weisdorf DJ, Wagner JE, et al. Response of 443 patients to steroids as primary therapy for acute graft-versus-host disease: comparison of grading systems. Biol Blood Marrow Transplant. 2002;8(7):387-394.
- Schoemans HM, Lee SJ, Ferrara JL, et al. EBMT—NIH—CIBMTR Task Force position statement on standardized terminology & guidance for graft-versus-host disease assessment. Bone Marrow Transplant. 2018;53(11):1401-1415.
- Hill L, Alousi A, Kebriaei P, et al. New and emerging therapies for acute and chronic graft versus host disease. Ther Adv Hematol. 2018;9(1):21-46.
- Mendoza KA, Chen H, Englehardt BG, et al. Similar outcomes in early failure steroid dependent acute GvHD and upfront steroid refractory acute GvHD. Presented at: 59th American Society of Hematology (ASH) Annual Meeting and Exposition; December 9-12, 2017; Atlanta, GA; Abstract 1975.
- Das-Gupta E, Greinix H, Jacobs R, et al. Extracorporeal photopheresis as second-line treatment for acute graft-versus-host disease: impact on six-month freedom from treatment failure. Haematologica. 2014;99(11):1746-1752.