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Treatment of chronic GVHD

Bone Marrow Transplantation volume 26, pages 460–461 (2000)Cite this article

We thought that Gaziev et al1 presented an excellent review of chronic GVHD. We believe that two important issues deserve further comment. In several sections regarding ‘promising’ drugs, the authors comment that the drug may be useful for treatment of chronic GVHD. We think that it is critical to emphasize their comment in the abstract and conclusions that ‘randomized clinical trials must be performed earlier in the course of cGVHD to establish the efficacy of these new drugs’. Although phase II trials suggest drug efficacy, only phase III trials can prove the impact of therapies. This was exactly the case for azathioprine, which was ‘promising’ in early studies, but which worsened outcome when added to prednisone therapy in a randomized phase III trial.2

Another very important point is the omission of hydroxychloroquine (HCQ) therapy of chronic GVHD. The omission itself may be understandable, since other drugs such as rapamycin and deoxyspergualin were also omitted, and it is a challenge to be comprehensive in a rapidly changing field. However, it is important to mention hydroxychloroquine because of the current status of clinical trials. We have published extensively on the immunomodulatory effects of HCQ on alloreactivity, immune responses, and preclinical GVHD models.345678 A phase II trial of HCQ has been presented twice.910 The manuscript describing this trial is in press.11 Most importantly, a very large phase III trial comparing standard therapy (prednisone/CsA) in combination with HCQ or placebo will open in July 2000. The trial will be funded by the NIH and conducted by the Children's Oncology Group. The trial also includes extensive laboratory evaluations to evaluate the pathogenesis of cGVHD. The trial represents the first randomized phase III multi-center trial of chronic GVHD, and will hopefully initiate a new mechanism for rapidly advancing our understanding of chronic GVHD and for determining the effectiveness of treatment.

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References

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Authors and Affiliations

  1. Division of Hematology/Oncology 2401 Gillman Rd, The Children's Mercy Hospital, Kansas City, MO 64108, USA

    AL Gilman

  2. Department of Pediatrics, University of British Columbia, Vancouver, BC Z6H3V4, Canada

    KR Schultz

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Gilman, A., Schultz, K. Treatment of chronic GVHD. Bone Marrow Transplant 26, 460–461 (2000). https://doi.org/10.1038/sj.bmt.1702530

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