Chronic Graft-versus-Host Disease: A Long Road Ahead.
Chronic Graft-versus-Host Disease: A Long Road Ahead.
复制标题
慢性移植物抗宿主病：前面的路很长。
DOI：
10.1016/j.bbmt.2018.01.010
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发表时间：
2018
期刊：
影响因子：
--
通讯作者：
Sarantopoulos,Stefanie
中科院分区：
文献类型：
--
作者：
Anand,Sarah;Sarantopoulos,Stefanie
Chronic graft-versus-host disease (GVHD) remains a significant contributor to long-term morbidity and mortality after allogeneic hematopoietic cell transplantation (HCT). Up to half of all HCT patients will develop chronic GVHD, and patients with moderate to severe disease require systemic immunosuppressive therapy (IST) 1, 2. In their study, Lee et al.[3] closely follow the pattern of IST use in clinical practice in a single-center cohort of 250 chronic GVHD patients enrolled in their prospective observational study. After a median follow-up of 5.6 years, only about one third of survivors were alive and off IST, whereas one third remained on IST (with half past third-line therapy) and one third relapsed or died. The most remarkable finding was that only a minority of patients were alive and off IST years after allogeneic HCT, highlighting the suboptimal efficacy of current chronic GVHD treatment.This study further assessed the success rate of individual first and subsequent lines of IST by failure-free survival, defined as no additional systemic therapy and no relapse or death in 6 months. For any given agent in any line of therapy, the failure-free survival rate was quite low ranging, from 10% to 30%, and the majority of patients received 3 or more lines of therapy. The pattern of IST discontinuation was also examined in this study; only half of all patients underwent an initial attempt at IST discontinuation. After stopping IST the first time, about half the patients had to restart IST at a median of 3.4 months. Subsequent attempts to stop IST were met with one third of patients having to restart therapy at a median of 6 months. Increased length of time from transplant was identified as a predictor for successfully stopping IST, while oral and skin manifestations were associated with restarting IST. In a subset analysis of patients enrolled within 3 months of chronic GVHD diagnosis, the median time to permanent IST discontinuation was 69 months. This detailed clinical data illustrate the protracted, complex treatment course experienced by patients with chronic GVHD.
