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Retrospective single center analysis of outcome, risk factors and therapy in steroid refractory graft-versus-host disease after allogeneic hematopoietic cell transplantation

Bone Marrow Transplantation volume 54, pages 1805–1814 (2019)Cite this article

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Abstract

Acute and chronic graft-vs.-host disease (aGvHD and cGvHD) are major complications after allogeneic hematopoietic cell transplantation (HCT) leading to substantial morbidity and mortality. This retrospective single-center study analyzes incidence, therapy, and outcome of GvHD in n = 721 patients ≥18 years having received allogeneic HCT 2004–2013 with a special focus on steroid refractory GvHD. Acute (n = 355/49.2%) and chronic (n = 269/37.3%) GvHD were mainly treated by steroids in first-line therapy. The proportion of steroid refractory aGvHD and cGvHD was 35.7% and 31.4%, respectively. As there is no standard therapy for steroid refractory GvHD, a range of different agents was used. In aGvHD, the overall response rate (ORR) of steroid refractory GvHD to second-line treatment was 27.4%. Mycophenolate mofetil (MMF) and mTOR inhibitors led to superior response rates (ORR 50.0% and 53.3%, respectively). In steroid refractory cGvHD therapy, ORR was 44.4%. Use of calcineurin inhibitors (CNI; n = 11/45.5%), MMF (n = 18/50.0%), mTOR inhibitors (n = 10/60.0%), and extracorporeal photophoresis (ECP; n = 16/56.3%) showed ORR above average. Targeted therapies lead to responses in 7.7% (n = 13). This data may help to improve the design of future prospective clinical studies in GvHD.

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Acknowledgements

We thank Diana Kilian for maintaining our HCT database and the nurses and staff of the transplantation ward and outpatient clinic.

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  1. Department of Hematology and Oncology, Medical Center University Hospital Tuebingen, Tuebingen, Germany

    L. Axt, J. Toennies, S. P. Haen, W. Vogel, D. Schneidawind, S. Wirths, R. Moehle, C. Faul, L. Kanz & W. A. Bethge

  2. Institute for Clinical Epidemiology and Applied Biometry, Eberhard-Karl University Tuebingen, Tuebingen, Germany

    A. Naumann

  3. Department for Visceral, General and Transplant Surgery, University Hospital Tuebingen, Tuebingen, Germany

    S. Axt

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Axt, L., Naumann, A., Toennies, J. et al. Retrospective single center analysis of outcome, risk factors and therapy in steroid refractory graft-versus-host disease after allogeneic hematopoietic cell transplantation. Bone Marrow Transplant 54, 1805–1814 (2019). https://doi.org/10.1038/s41409-019-0544-y

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