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Graft-Versus-Host Disease

‘Real-life’ report on the management of chronic GvHD in the Gruppo Italiano Trapianto Midollo Osseo (GITMO)

Bone Marrow Transplantation volume 53, pages 58–63 (2018)Cite this article

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Abstract

Several guidelines have been published about management of chronic GvHD (cGvHD), but the clinical practice still remains demanding. The Gruppo Italiano Trapianto di Midollo Osseo (GITMO) has planned a prospective observational study on cGvHD, supported by a dedicated software, including the updated recommendations. In view of this study, two surveys have been conducted, focusing the management of cGvHD and ancillary therapy in cGvHD, to address the current ‘real life’ situation. The two surveys were sent to all 57 GITMO centers, performing allografting in Italy; the response rate was 57% and 66% of the interviewed centers, respectively. The first survey showed a great disparity especially regarding steroid-refractory cGvHD, although extracorporeal photo-apheresis resulted as the most indicated treatment in this setting. Another challenging issue was the strategy for tapering steroid: our survey showed a great variance, and this disagreement could be a real bias in evaluating outcomes in prospective studies. As for the second survey, the results suggest that the ancillary treatments are not standardized in many centers. All responding centers reported a strong need to standardize management of cGvHD and to participate in prospective trials. Before starting observational and/or interventional studies, a detailed knowledge of current practice should be encouraged.

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Acknowledgements

We thank all physicians, nurses and patients of participating centers.

Author information

Author notes

  1. F Bonifazi and A Olivieri: These authors contributed equally to this work.

Authors and Affiliations

  1. Department of Molecular Biotechnology and Health Sciences, and Department of Oncology, University of Torino, AOU Città della Salute e della Scienza di Torino, Torino, Italy

    L Giaccone & B Bruno

  2. Division of Hematology, Azienda Ospedaliera Universitaria Ospedali Riuniti, Ancona, Italy

    G Mancini, M Chiarucci & A Olivieri

  3. Division of Hematology, Azienda Ospedaliera S. Croce e Carle, Cuneo, Italy

    N Mordini

  4. UOC Ematology and TCSE, AOU Federico II, Napoli, Italy

    G Gargiulo & S Marotta

  5. UOC Oncoematology Pediatrica, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy

    V De Cecco

  6. Division of Hematology and Stem Cell Transplantation, Ospedale Mazzoni, Ascoli Piceno, Italy

    S Angelini

  7. Division of Hematology, University Hospital Sant'Orsola-Malpighi, Bologna, Italy

    M Arpinati & F Bonifazi

  8. Ospedale di Riferimento Regionale Businco, AO Brotzu, Cagliari, Italy

    D Baronciani

  9. Divisione di Ematologia, Ospedale di Lecce, Lecce, Italy

    V Bozzoli

  10. Division of Hematology, Ospedale Humanitas, Rozzano, Italy

    S Bramanti

  11. Department of Women's and Children's Health, Clinic of Pediatric Hemato-Oncology, University Hospital of Padova, Padova, Italy

    E Calore

  12. Hematology and Bone Marrow Transplant Unit, Ospedale Centrale di Bolzano, Bolzano, Italy

    I M Cavattoni

  13. UOC di Ematologia con TMO, Ospedale San Carlo, Potenza, Italy

    M Cimminiello

  14. Divisione di Ematologia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy

    A A Colombo

  15. Hematology Unit, Arcispedale S Maria Nuova-IRCCS, Reggio Emilia, Italy

    L Facchini

  16. U.O.C. Ematologia e Trapianto di Cellule Staminali Emopoietiche, Ospedale Mazzoni, Ascoli Piceno, Italy

    S Falcioni

  17. Department of Pediatric Hematology-Oncology, IRCCS G. Gaslini, Genova, Italy

    M Faraci

  18. Hematology and Stem Cell Transplant Unit, Azienda Ospedaliera Bianchi Melacrino Morelli, Reggio Calabria, Italy

    R Fedele

  19. Department of Hematology, Bone Marrow Transplant Unit, University of Firenze, Firenze, Italy

    S Guidi

  20. Department of ‘Cellular Biotechnologies and Hematology’, Azienda Policlinico Umberto I, Università La Sapienza, Roma, Italy

    A P Iori

  21. Hematology and Bone Marrow Transplant Unit, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy

    M C Micò

  22. Hematology and Bone Marrow Transplant Unit, Azienda Policlinico Vittorio Emanuele, Catania, Italy

    G Milone

  23. Hematology–BMT Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico–University of Milan, Milano, Italy

    F Onida

  24. Dipartimento di Ematologia, Università di Bari, Bari, Italy

    D Pastore

  25. Azienda Ospedaliera-Universitaria di Udine, DISM Università di Udine, Udine, Italy

    F Patriarca

  26. Hematology, AO SS Antonio e Biagio e C Arrigo, Alessandria, Italy

    M Pini

  27. Hematology and Bone Marrow Transplant Unit, Ospedale San Bortolo, Vicenza, Italy

    R Raimondi

  28. Paediatric Department, BMT Unit, MBBM Foundation, University of Milano-Bicocca, San Gerardo Hospital, Monza, Italy

    A Rovelli

  29. Unità Terapia Intensiva Ematologica per il Trapianto Emopoietico, Ospedale Civile, Pescara, Italy

    S Santarone

  30. Divisione di Ematologia, Ospedale San Camillo, Roma, Italy

    A Severino

  31. Department of Clinical and Experimental Sciences, Unit of Blood Disease and Stem Cell Transplantation, University of Brescia, AO Spedali Civili di Brescia, Brescia, Italy

    C Skert

  32. Molecular Hematology Laboratory, IRCCS San Raffaele Scientific Institute, Milano, Italy

    M T L Stanghellini

  33. Department of Medicine, Section of Hematology, University of Verona, Verona, Italy

    C Tecchio

  34. Pediatric Onco-Hematology and Stem Cell Transplant Division, AO Città della Salute e della Scienza di Torino, Torino, Italy

    E Vassallo

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  1. L Giaccone
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Corresponding author

Correspondence to L Giaccone.

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Giaccone, L., Mancini, G., Mordini, N. et al. ‘Real-life’ report on the management of chronic GvHD in the Gruppo Italiano Trapianto Midollo Osseo (GITMO). Bone Marrow Transplant 53, 58–63 (2018). https://doi.org/10.1038/bmt.2017.223

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