TLI in refractory chronic GVHD

Abstract

Refractory chronic GVHD (cGVHD) remains a major cause of morbidity after transplantation. Many drugs are used but there is no consensus on the standard of care. We investigated the efficacy of TLI in corticosteroid-refractory cGVHD. We analyzed retrospectively 31 patients receiving one or more TLI session for refractory cGVHD from 2000 to 2007. The main objective was to evaluate the response rate after TLI. Decreased corticosteroid doses and/or discontinued immunosuppressive agents were considered to be surrogate markers of response. All but one patient presented with severe cGVHD at the time of TLI. The median number of previous immunosuppressive treatment lines was 3 (range: 2-4). Fourteen patients (45%) achieved an objective response after TLI and 8 (25%) were cGVHD free at long-term follow-up. In all, 5 (29%) of the 17 nonresponsive patients did not show the features of progressive cGVHD and could decrease the amount of immunosuppressive drugs taken. Response after TLI significantly improved 5-year GVHD-related mortality (14% vs 42%, P ¼ 0.038) but not OS (58%vs 64% P ¼ 0.27). Regarding the promising response rate in this heavily pretreated population, we reasoned that TLI could be an alternative treatment for corticosteroid-refractory cGVHD.

Treatment of cutaneous and/or soft tissue manifestations of corticosteroids refractory chronic graft versus host disease (cGVHD) by a total nodal irradiation (TNI)

“…At 6 months, 57% of patients benefited from a dose reduction of corticosteroids, vs 41.6% in our retrospective series. A similar retrospective study conducted on 31 patients described 45% of overall response, with 41% of skin response (9/22) with no toxicity described by the authors. One patient was transfused in our series.…”

“…Descriptive data were summarized using median values, extreme and standard deviations, and the percentages for continuous or ordinal values. Survival data were not identified because of the lack of impact on the overall survival of the clinical response to TNI for treatment of cGVHD reactions in previous studies …”

Skin ulcers related to chronic graft-versus-host disease: clinical findings and associated morbidity

“…The median time of ulcer appearance after HSCT was long (44 months). Although most of the patients had a severe cGVHD, only four patients died during patient follow‐up [median time of follow‐up after ulcer onset = 55 months (38–77)], while Devillier et al . reported a 5‐year overall survival of 60% in patients with refractory cGVHD.…”

Acute and Chronic Graft-Versus-Host-Disease – A Focus on Pediatric Patients

“…The best responses are seen for mucocutaneous cGVHD, particularly for fasciitis and GVHD of the mouth. TAI has also been shown to allow for systemic steroid tapering 90,130 .…”