Consensus Conference on Clinical Practice in Chronic GVHD: Second-Line Treatment of Chronic Graft-versus-Host Disease
Consensus Conference on Clinical Practice in Chronic GVHD: Second-Line Treatment of Chronic Graft-versus-Host Disease
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DOI：
10.1016/j.bbmt.2010.05.011
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发表时间：
2011-01-01
影响因子：
4.3
通讯作者：
Holler, Ernst
中科院分区：
文献类型：
--
作者：
Wolff, Daniel;Schleuning, Michael;Holler, Ernst
类固醇难治性慢性移植物抗宿主病（cGVHD）与显着的发病率和死亡率相关。尽管cGVHD的一线治疗基于对照试验，但二线治疗几乎完全基于II期试验或回顾性分析。在雷根斯堡举行的cGVHD临床实践共识会议旨在就当前治疗方案的证据达成共识，并为日常临床实践提供指南。治疗方式包括使用类固醇和钙调神经磷酸酶抑制剂以及免疫调节方式（光去除术、mTOR抑制剂、沙利度胺、羟氯喹、维生素A类似物、氯法齐明）和细胞抑制剂（吗替麦考酚酯、甲氨蝶呤、环磷酰胺、喷司他丁）。最近的报告显示，利妥昔单抗、阿仑单抗和依那西普对选定的患者有一定疗效。此外，伊马替尼等酪氨酸激酶抑制剂进入该领域是因为它们能够干扰参与纤维化的血小板衍生生长因子（PDGF-R）途径。另一种治疗选择是低剂量胸腹照射。尽管有不同的治疗方案可供选择，但“试错系统”仍然是确定药物对个体患者有效的唯一方法，并且迫切需要有效的生物标志物来提前确定对药物产生反应的可能性。此外，大多数治疗实体的证据很少表明迫切需要对 cGVHD 的二线治疗方案进行系统评估。 Biol 血液骨髓移植 17: 1-17 (2011) (C) 2011 美国血液和骨髓移植学会
Steroid refractory chronic graft-versus-host disease (cGVHD) is associated with a significant morbidity and mortality. Although first-line treatment of cGVHD is based on controlled trials, second-line treatment is almost solely based on phase II trials or retrospective analyses. The consensus conference on clinical practice in cGVHD held in Regensburg aimed to achieve a consensus on the current evidence of treatment options as well as to provide guidelines for daily clinical practice. Treatment modalities are the use of steroids and calcineurin inhibitors as well as immunomodulating modalities (photopheresis, mTOR-inhibitors, thalidomide, hydroxychloroquine, vitamin A analogs, clofazimine), and cytostatic agents (mycophenolate mofetil, methotrexate, cyclophosphamide, pentostatin). Recent reports showed some efficacy of rituximab, alemtuzumab, and etanercept in selected patients. Moreover, tyrosine kinase inhibitors such as imatinib came into the field because of their ability to interfere with the platelet-derived growth factor (PDGF-R) pathway involved in fibrosis. An other treatment option is low-dose thoracoabdominal irradiation. Although different treatment options are available, the "trial-and-error system" remains the only way to identify the drug effective in the individual patient, and valid biomarkers are eagerly needed to identify the likelihood of response to a drug in advance. Moreover, the sparse evidence for most treatment entities indicates the urgent need for systematic evaluation of second-line treatment options in cGVHD. Biol Blood Marrow Transplant 17: 1-17 (2011) (C) 2011 American Society for Blood and Marrow Transplantation