Next generation treatment of acute graft-versus-host disease

Magenau, John; Reddy, Pavan

doi:10.1038/leu.2014.195

Cited by 29 publications

(24 citation statements)

References 78 publications

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“…Rationally designed treatments that inhibit deregulated pathways in malignant cells are typically the focus of 'targeted' therapy. In GvHD, the 'target' is elusive, as the goal is to carefully contain an overzealous but biologically normal immunologic response (Magenau and Reddy 2014). Success in prophylaxis and treatment of GvHD will depend on whether GvHD can be prevented without losing the antitumour effect.…”

Section: The Futurementioning

confidence: 99%

“…Acute GvHD is modulated in part by the presence of cells capable of inhibiting immune responses, most notably regulatory T cells (Magenau and Reddy 2014) (Fig. 11.1).…”

Section: Pathophysiology Of Gvhdmentioning

confidence: 99%

“…Therefore, broad-based immunosuppressive strategies are less attractive as these may dampen the GvT benefit. Relapse accounts for a significant proportion of treatment failures after HSCT; thus strategies for GvHD prevention with minimal impact on GvT are the holy grail of transplantation (Magenau and Reddy 2014).…”

Section: Background To Gvhdmentioning

confidence: 99%

“…There is currently no standard time for assessing the effectiveness of the steroids with a time gap of 3-7 days often given as indicative of treatment failure and requiring escalation to second-line therapies. The GvHD may at this point be labelled as 'steroid refractory disease' which carries a dismal long-term prognosis (Magenau and Reddy 2014) with infection being the leading cause of mortality followed by organ failure in nonresponders (Greinix 2008). Below is a list of second-and third-line treatment options for those who have had their CNI optimised and have failed to respond to corticosteroids for at least 7 days.…”

Section: Initial Treatment Of Acute Gvhdmentioning

confidence: 99%

“…A complex network of cytokines, chemokines, cellular receptors and immune cell subsets then modulate T-cell/APC interactions that result in the initiation and maintenance of GvHD (Magenau and Reddy 2014).…”

Section: Pathophysiology Of Gvhdmentioning

confidence: 99%

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Graft-Versus-Host Disease (GvHD)

Murray

Stringer

Hutt

2017

The European Blood and Marrow Transplantation Textbook for Nurses

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Acute and chronic graft-versus-host disease (GvHD) is a major cause of morbidity and mortality in patients who undergo allogeneic haematopoietic cell transplantation (HCT) and affects approximately 30-40% of recipients. Its diagnosis is complicated, and staging of the disease varies dependent upon the transplant centre involved. Standardisation through the use of National Institute of Health (NIH) guidelines helps clinicians diagnose and treat their patients more effectively. For the majority of patients who go on to develop GvHD, corticosteroids remain the first-line treatment for both acute and chronic GvHD. Recipients that are refractory to systemic steroids have a plethora of second-and third-line options available to them. A 'standard of care' approach has not yet become agreed globally due to poor evidence from small and limited randomised control trials. Supportive care is paramount, and the nurse is often at the centre of the patients care and in the best position to guide and advise the patient and family through this often long-term complication.

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Section: The Futurementioning

confidence: 99%

“…Acute GvHD is modulated in part by the presence of cells capable of inhibiting immune responses, most notably regulatory T cells (Magenau and Reddy 2014) (Fig. 11.1).…”

Section: Pathophysiology Of Gvhdmentioning

confidence: 99%

Section: Background To Gvhdmentioning

confidence: 99%

Section: Initial Treatment Of Acute Gvhdmentioning

confidence: 99%

Section: Pathophysiology Of Gvhdmentioning

confidence: 99%

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Graft-Versus-Host Disease (GvHD)

Murray

Stringer

Hutt

2017

The European Blood and Marrow Transplantation Textbook for Nurses

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Extracorporeal photopheresis for graft versus host disease: Identifying a clinical pathway and associated resource utilization

Yerrabothala

Talebian²,

Klinker

et al. 2017

J of Clinical Apheresis

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Extracorporeal photopheresis (ECP) is an established therapy for the treatment of graft-versus-host-disease (GVHD) following an allogeneic stem cell transplant. We performed a prospective analysis of patients receiving ECP treatment for GVHD to identify a clinical pathway and resource utilization of this process. The cohort included consecutive allogeneic stem cell recipients with GVHD. ECP was performed using the CELLEX Photopheresis System or the UVAR XTS Photopheresis System (Therakos, Inc, Exton, PA). A clinical pathway was developed and a time and motion study was conducted to define the resource utilization and costs associated with ECP. Patients were treated with either CELLEX (n = 18 procedures) or UVAR (n = 4 procedures). Total time commitment for each procedure for the 2 machines differed. The time for ECP was 117 min (median, range: 91-164 min) using CELLEX and 161 min (median; range: 140-210) using the UVAR-XTS machine. Total costs of each ECP procedure were $3420.50. There is a considerable time commitment of the patient and the clinical staff when employing ECP to treat GVHD. ECP costs are significant considering this is a prolonged therapy continued for several months. With this finalized pathway and costs, we have a standardized clinical pathway for the treatment of GVHD. We are addressing minimizing resource utilization while emphasizing quality care for these patients.

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Graft-Versus-Host Disease (GvHD)

Murray

Stringer

Hutt

2023

The European Blood and Marrow Transplantation Textbook for Nurses

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Acute and chronic graft-versus-host disease (GvHD) is a major cause of morbidity and mortality in patients who undergo allogeneic haematopoietic cell transplantation (HCT) and affects approximately 30–40% of recipients. Prevention remains the goal, and the recent introduction of post-transplant cyclophosphamide in the haploidentical transplant setting is changing the landscape. GvHD diagnosis is complicated, and grading and staging vary depending upon the tool and transplant centre involved. For the majority of patients who go on to develop GvHD, corticosteroids remain the first-line treatment for both acute and chronic forms of the disease. Recipients that are refractory to systemic steroids have a plethora of second- and third-line options available to them. A ‘standard of care’ approach has not yet become agreed globally due to poor evidence from small and limited randomised control trials. However, the recent REACH (Zeiser et al. N Engl J Med. 382(19):1800–10, 2020; Zeiser et al. N Engl J Med. 385(3):228–38, 2021) and ROCKstar trials (Cutler et al. Blood. 38(22):2278–89, 2021) have armed clinicians with new and effective therapies. Supportive care is paramount, and the nurse is at the centre of the patient’s care and in the best position to guide and advise the patient and family through this often-long-term complication.

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Next generation treatment of acute graft-versus-host disease

Cited by 29 publications

References 78 publications

Graft-Versus-Host Disease (GvHD)

Graft-Versus-Host Disease (GvHD)

Extracorporeal photopheresis for graft versus host disease: Identifying a clinical pathway and associated resource utilization

Graft-Versus-Host Disease (GvHD)

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