Abstract

Chronic graft-versus-host disease (cGVHD) is one of the major causes of late mortality after allogenic hematopoietic stem cell transplantation. Moderate-to-severe cGVHD is associated with poor health-related quality of life and substantial disease burden. While corticosteroids with or without calcineurin inhibitors comprise the first-line treatment option, the prognosis for patients with steroid-refractory cGVHD (SR-cGVHD) remains poor. The mechanisms underlying steroid resistance are unclear, and there are no standard second-line treatment guidelines for patients with SR-cGVHD. In this review, we provide an overview on current treatment options of cGVHD and use a series of theoretical case studies to elucidate the rationale of choices of second- and third-line treatment options for patients with SR-cGVHD based on individual patient profiles.

Details

Title
Steroid-refractory chronic graft-versus-host disease: treatment options and patient management
Author
Wolff, Daniel 1   VIAFID ORCID Logo  ; Fatobene Giancarlo 2 ; Rocha Vanderson 2 ; Kröger Nicolaus 3   VIAFID ORCID Logo  ; Flowers, Mary E 4 

1  University Hospital Regensburg, Department of Internal Medicine III, Regensburg, Germany (GRID:grid.411941.8) (ISNI:0000 0000 9194 7179) 
2  Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP), São Paulo, Brazil (GRID:grid.411074.7) (ISNI:0000 0001 2297 2036); Vila Nova Star Hospital and IDOR, Rede D’Or, São Paulo, Brazil (GRID:grid.411074.7) 
3  University Medical Center Hamburg, Department of Stem Cell Transplantation, Hamburg, Germany (GRID:grid.13648.38) (ISNI:0000 0001 2180 3484) 
4  University of Washington, Seattle, Clinical Research Division, Fred Hutchinson Cancer Research Center and Department of Medicine, Seattle, USA (GRID:grid.34477.33) (ISNI:0000000122986657) 
Pages
2079-2087
Publication year
2021
Publication date
Sep 2021
Publisher
Nature Publishing Group
ISSN
02683369
e-ISSN
14765365
Source type
Scholarly Journal
Language of publication
English
DOI
https://doi.org/10.1038/s41409-021-01389-5
ProQuest document ID
2568102897
Copyright
© The Author(s) 2021. This work is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.