Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Correspondence
  • Published:

‘To treat or not to treat’: raising awareness on the effects of graft versus host disease drugs on musculoskeletal system

Bone Marrow Transplantation volume 53, pages 909–912 (2018)Cite this article

Subjects

With an increase in the rate of survival of hematopoietic cell transplant (HCT) patients, the burden of late post-transplant complications also has increased tremendously. Unlike acute graft-versus-host-disease (GVHD), chronic GVHD and its complications may present in a variety of manifestations including scleroderma, fasciitis, polymyositis, myopathies, Sjögren’s syndrome, neurological sequelae, primary biliary cirrhosis, vaginal GVHD, wasting syndrome, genital GVHD, bronchiolitis obliterans, immune cytopenias, and chronic immunodeficiency [1, 2].

From the functional quality of life point of view, the main aim of the management is to help improve overall function, joint range of motion, prevent contractures, aid the bone matrix, improve tissue-healing process, improve quality of life, and reduce pain. Currently, the main complimentary choice of therapy for managing musculoskeletal manifestation (MSK) of chronic GVHD seems to be largely focused on exercise therapy [3].

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

References

  1. Lee SJ, Vogelsang G, Flowers ME. Chronic graft-versus-host disease. Biol Blood Marrow Transplant. 2003;9:215–33.

    Article  PubMed  CAS  Google Scholar 

  2. Flowers MED, Vogelsang GB. Clinical manifestations and natural history. In: Vogelsang GB, Pavletic SZ (eds). Chronic Graft Versus Host Disease: Interdisciplinary Management. New York, NY, USA: Cambridge University Press; 2009. pp 56–69.

    Chapter  Google Scholar 

  3. Mohammed J, Savani B, El-Jawahri A, Vanderklish J, Cheville A, Hashmi S. Is there any role for physical therapy in chronic GvHD?. Bone Marrow Transplant. 2018;53:22–28.

    Article  PubMed  CAS  Google Scholar 

  4. Holler E. Risk assessment in haematopoietic stem cell transplantation: GvHD prevention and treatment. Best Pract Res Clin Haematol. 2007;20:281–94.

    Article  PubMed  CAS  Google Scholar 

  5. Fujii N, Ikeda K, Koyama M, Aoyama K, Masunari T, Kondo E, et al. Calcineurininhibitor—induced irreversible neuropathic pain after allogeneic hematopoietic stem cell transplantatioan. Int J Hematol. 2006;83:459–61.

    Article  PubMed  Google Scholar 

  6. Collini A, De Bartolomeis C, Barni R, Ruggieri G, Bernini M, Carmellini M. Calcineurin-inhibitor induced pain syndrome after organ transplantation. Kidney Int. 2006;70:1367–70.

    Article  PubMed  CAS  Google Scholar 

  7. Naredo SE, Balsa CA, Sanz GA, Pantoja ZL, Martín ME, Gijón BJ. Leg bone pain syndrome due to cyclosporine in a renal transplant patient. Clin Exp Rheumatol. 1993;12:653–6.

    Google Scholar 

  8. Van Lint MT, Milone G, Leotta S, Uderzo C, Scime R, Dallorso S, et al. Treatment of acute graft-versus-host disease with prednisolone: significant survival advantage for day+ 5 responders and no advantage for nonresponders receiving anti–thymocyte globulin. Blood. 2006;107:4177–81.

    Article  PubMed  CAS  Google Scholar 

  9. Dignan FL, Amrolia P, Clark A, Cornish J, Jackson G, Mahendra P, et al. Diagnosis and management of chronic graft‐versus‐host disease. Br J Haematol. 2012;158:46–61.

    Article  PubMed  CAS  Google Scholar 

  10. Gergis U, Markey K, Greene J, Kharfan-Dabaja M, Field T, Wetzstein G, et al. Voriconazole provides effective prophylaxis for invasive fungal infection in patients receiving glucocorticoid therapy for GVHD. Bone Marrow Transplant. 2010;45:662–7.

    Article  PubMed  CAS  Google Scholar 

  11. Balasubramanian A, Wade SW, Adler RA, Lin CJ, Maricic M, O’Malley CD, et al. Glucocorticoid exposure and fracture risk in patients with new-onset rheumatoid arthritis. Osteoporos Int. 2016;27:3239–49.

    Article  PubMed  CAS  Google Scholar 

  12. Li X, Brazauskas R, Wang Z, Al-Seraihy A, Baker KS, Cahn JY, et al. Avascular necrosis of bone after allogeneic hematopoietic cell transplantation in children and adolescents. Biol Blood Marrow Transplant. 2014;20:587–92.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  13. Montalbano M, Neff GW, Yamashiki N, Meyer D, Bettiol M, Slapak-Green G, et al. A retrospective review of liver transplant patients treated with sirolimus from a single center: an analysis of sirolimus-related complications. Transplantation. 2004;78:264–8.

    Article  PubMed  CAS  Google Scholar 

  14. Stallone G, Infante B, Grandaliano G, Gesualdo L. Management of side effects of sirolimus therapy. Transplantation. 2009;87(8S):S23–6.

    Article  PubMed  CAS  Google Scholar 

  15. Xu SL, Zhang YC, Wang GY, Yang Q, Liu B, Zhang J, et al. Survival analysis of sirolimus-based immunosuppression in liver transplantation in patients with hepatocellular carcinoma. Clin Res Hepatol Gastroenterol. 2016;40:674–81.

    Article  PubMed  CAS  Google Scholar 

  16. Merin NM, Kelly KR. Clinical use of proteasome inhibitors in the treatment of multiple myeloma. Pharmaceuticals. 2016;8:1–20.

    Article  CAS  Google Scholar 

  17. Richardson PG, Delforge M, Beksac M, Wen P, Jongen JL, Sezer O, et al. Management of treatment-emergent peripheral neuropathy in multiple myeloma. Leukemia. 2012;26:595–608.

    Article  PubMed  CAS  Google Scholar 

  18. Richardson PG, Briemberg H, Jagannath S, Wen PY, Barlogie B, Berenson J, et al. Frequency, characteristics, and reversibility of peripheral neuropathy during treatment of advanced multiple myeloma with bortezomib. J Clin Oncol. 2006;24:3113–20.

    Article  PubMed  CAS  Google Scholar 

  19. Palumbo A, Bringhen S, Larocca A, Rossi D, Di Raimondo F, Magarotto V, et al. Bortezomib-melphalan-prednisone-thalidomide followed by maintenance with bortezomib-thalidomide compared with bortezomib-melphalan-prednisone for initial treatment of multiple myeloma: updated follow-up and improved survival. J Clin Oncol. 2014;32:634–40.

    Article  PubMed  CAS  Google Scholar 

  20. Humpel N, Iverson DC. Review and critique of the quality of exercise recommendations for cancer patients and survivors. Support Care Cancer. 2005;13:493–502.

    Article  PubMed  Google Scholar 

  21. Vannucchi AM, Kiladjian JJ, Griesshammer M, Masszi T, Durrant S, Passamonti F, et al. Ruxolitinib versus standard therapy for the treatment of polycythemia vera. New Engl J Med. 2015;372:426–35.

    Article  PubMed  CAS  Google Scholar 

  22. Eghtedar A, Verstovsek S, Estrov Z, Burger J, Cortes J, Bivins C, et al. Phase 2 study of the JAK kinase inhibitor ruxolitinib in patients with refractory leukemias, including postmyeloproliferative neoplasm acute myeloid leukemia. Blood. 2012;119:4614–8.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  23. Harrison C, Mesa R, Ross D, Mead A, Keohane C, Gotlib J, et al. Practical management of patients with myelofibrosis receiving ruxolitinib. Expert Rev Hematol. 2013;6:511–23.

    Article  PubMed  CAS  Google Scholar 

  24. Dahl K, Battisti JL. CNS demyelination during Anti TNF-alpha therapy (P4. 067). Neurology. 2015;84:P4–067.

    Google Scholar 

  25. Rupasree Y, Naushad SM, Rajasekhar L, Uma A, Kutala VK. Association of TLR4 (D299G, T399I), TLR9− 1486 T > C, TIRAP S180L and TNF-α promoter (− 1031,− 863,− 857) polymorphisms with risk for systemic lupus erythematosus among South Indians. Lupus. 2015;24:50–7.

    Article  PubMed  CAS  Google Scholar 

  26. Psarelis S, Hajineocli AP, Hadjicosta E, Elliott HS, Johnson P. Is secukinumab a safe alternative treatment for ankylosing spondylitis with Guillain Barré syndrome after anti-TNF-α treatment? Case report and literature review. Clin Rheumatol. 2017;36:1197–9.

    Article  PubMed  Google Scholar 

  27. Kaltsonoudis E, Zikou AK, Voulgari PV, Konitsiotis S, Argyropoulou MI, Drosos AA. Neurological adverse events in patients receiving anti-TNF therapy: a prospective imaging and electrophysiological study. Arthritis Res Ther. 2014;16:R125.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  28. Advani RH, Buggy JJ, Sharman JP, Smith SM, Boyd TE, Grant B, et al. Bruton tyrosine kinase inhibitor ibrutinib (PCI-32765) has significant activity in patients with relapsed/refractory B-cell malignancies. J Clin Oncol. 2012;31:88–94.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  29. Sarcon A, Botta GP, Patel N, Saven A. Spontaneous iliopsoas muscle hemorrhage secondary to ibrutinib (Imbruvica; Pharmacyclics) brief report. J Invest Med High Impact case Rep. 2016;4:2324709616648457.

    Google Scholar 

Download references

Author contributions

JM, TA, and SKH wrote the first draft of the manuscript. All authors contributed substantially to the conception, acquisition, analysis, and interpretation of the data for the work.

Author information

Author notes

  1. The opinions or assertions contained herein are the private views of the authors and are not to be construed as official or reflecting the views of the US Army or US Department of Defence.

Authors and Affiliations

  1. Department of Physical Therapy and Rehabilitation, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia

    Jaleel Mohammed

  2. Physical Therapy Association for Graft Versus Host Disease, Swindon, UK

    Jaleel Mohammed

  3. MSU-E, US Army, Kaiserslautern, Germany

    Tola Akomolafe

  4. Department of Adult Hematology and Stem Cell Transplant, King Faisal Hospital and Research Center, Riyadh, Saudi Arabia

    Mahmoud Aljurf & Shahrukh K. Hashmi

  5. Department of Medicine, Vanderbilt University, Nashville, TN, USA

    Bipin Savani

  6. Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA

    Shahrukh K. Hashmi

Authors
  1. Jaleel Mohammed
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Tola Akomolafe
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mahmoud Aljurf
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Bipin Savani
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Shahrukh K. Hashmi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jaleel Mohammed.

Ethics declarations

Conflicts of interest

There are no conflicts of interest to disclose from any authors.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Mohammed, J., Akomolafe, T., Aljurf, M. et al. ‘To treat or not to treat’: raising awareness on the effects of graft versus host disease drugs on musculoskeletal system. Bone Marrow Transplant 53, 909–912 (2018). https://doi.org/10.1038/s41409-018-0095-7

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41409-018-0095-7

Search

Advanced search

Quick links