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How I treat refractory chronic graft-versus-host disease.

Publication ,  Journal Article
Sarantopoulos, S; Cardones, AR; Sullivan, KM
Published in: Blood
March 14, 2019

Approximately 35% to 50% of patients otherwise cured of hematologic malignancies after allogeneic hematopoietic stem cell transplantation will develop the pleomorphic autoimmune-like syndrome known as chronic graft-versus-host disease (cGVHD). Since in 2005, National Institutes of Health (NIH) consensus panels have proposed definitions and classifications of disease to standardize treatment trials. Recently, the first agent was approved by the US Food and Drug Administration for steroid-refractory cGVHD. Despite these advances, most individuals do not achieve durable resolution of disease activity with initial treatment. Moreover, standardized recommendations on how to best implement existing and novel immunomodulatory agents and taper salvage agents are often lacking. Given the potential life-threatening nature of cGVHD, we employ in our practice patient assessment templates at each clinic visit to elucidate known prognostic indicators and red flags. We find NIH scoring templates practical for ongoing assessments of these complex patient cases and determination of when changes in immunosuppressive therapy are warranted. Patients not eligible or suitable for clinical trials have systemic and organ-directed adjunctive treatments crafted in a multidisciplinary clinic. Herein, we review these treatment options and offer a management and monitoring scaffold for representative patients with cGVHD not responding to initial therapy.

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Published In

Blood

DOI

EISSN

1528-0020

Publication Date

March 14, 2019

Volume

133

Issue

11

Start / End Page

1191 / 1200

Location

United States

Related Subject Headings

  • Severity of Illness Index
  • Salvage Therapy
  • Prognosis
  • Middle Aged
  • Male
  • Immunosuppressive Agents
  • Immunosuppression Therapy
  • Immunology
  • Humans
  • Hematopoietic Stem Cell Transplantation
 

Citation

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Sarantopoulos, S., Cardones, A. R., & Sullivan, K. M. (2019). How I treat refractory chronic graft-versus-host disease. Blood, 133(11), 1191–1200. https://doi.org/10.1182/blood-2018-04-785899
Sarantopoulos, Stefanie, Adela R. Cardones, and Keith M. Sullivan. “How I treat refractory chronic graft-versus-host disease.Blood 133, no. 11 (March 14, 2019): 1191–1200. https://doi.org/10.1182/blood-2018-04-785899.
Sarantopoulos S, Cardones AR, Sullivan KM. How I treat refractory chronic graft-versus-host disease. Blood. 2019 Mar 14;133(11):1191–200.
Sarantopoulos, Stefanie, et al. “How I treat refractory chronic graft-versus-host disease.Blood, vol. 133, no. 11, Mar. 2019, pp. 1191–200. Pubmed, doi:10.1182/blood-2018-04-785899.
Sarantopoulos S, Cardones AR, Sullivan KM. How I treat refractory chronic graft-versus-host disease. Blood. 2019 Mar 14;133(11):1191–1200.

Published In

Blood

DOI

EISSN

1528-0020

Publication Date

March 14, 2019

Volume

133

Issue

11

Start / End Page

1191 / 1200

Location

United States

Related Subject Headings

  • Severity of Illness Index
  • Salvage Therapy
  • Prognosis
  • Middle Aged
  • Male
  • Immunosuppressive Agents
  • Immunosuppression Therapy
  • Immunology
  • Humans
  • Hematopoietic Stem Cell Transplantation