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Navigating the Complexity of Chronic Graft-vs-Host Disease: Canadian Insights into Real-World Treatment Sequencing.
- Source :
-
Transplantation proceedings [Transplant Proc] 2024 Mar; Vol. 56 (2), pp. 409-415. Date of Electronic Publication: 2024 Feb 10. - Publication Year :
- 2024
-
Abstract
- Background: Graft-vs-Host Disease (GVHD) is a donor immune-mediated syndrome occurring in patients who undergo an allogeneic hematopoietic cell transplant (HCT). Chronic GVHD (cGVHD) presents with complications of variable severity. Corticosteroids are standard first-line (1L) treatment, but the sequence after 1L is unclear with the availability of new treatments. This research aimed to understand real-world treatment sequencing for cGVHD.<br />Methods: This retrospective study investigated adult patients across 7 treatment sites in Canada who had received an allogeneic HCT >18 months prior to the study, experienced cGVHD, and received systemic treatment, including extracorporeal photopheresis (ECP).<br />Results: A total of 77 cases were reviewed retrospectively (median age = 51 (IQR 41-62), 51% female). 59 patients remained on active systemic treatment, and among this group, the most common treatments in use were corticosteroids (47%) and ruxolitinib (47%). One patient died, and 17 patients were on non-systemic treatment after complications resolved. The median lines of treatment (LOT) received was 2 (IQR 1-3), with 39% of patients having received >2 LOT. Among patients with lung complications (n = 24), 41% had received 3 or more LOT. Among patients with scleroderma (n = 22), 77% had received 3 or more LOT, 23% of which had received 6 or more unique treatments.<br />Conclusions: The first treatment given to cGVHD patients was corticosteroids. Ruxolitinib was the most used second-line treatment. About 40% of cGVHD patients received >2 treatments, and scleroderma was associated with more LOT. There is a need for more effective cGVHD treatment options when early treatments fail to resolve complications.<br />Competing Interests: Declaration of competing interest This study was supported by Sanofi Canada. Dr Dennis Kim reports a relationship with Sanofi Canada Inc that includes: board membership, consulting or advisory, speaking and lecture fees, and travel reimbursement. Dr Dennis Kim reports a relationship with Novartis Pharmaceuticals Canada Inc that includes: board membership, consulting or advisory, funding grants, and speaking and lecture fees.<br /> (Copyright © 2024. Published by Elsevier Inc.)
- Subjects :
- Adult
Humans
Female
Middle Aged
Male
Retrospective Studies
Canada
Adrenal Cortex Hormones therapeutic use
Chronic Disease
Hematopoietic Stem Cell Transplantation adverse effects
Graft vs Host Disease diagnosis
Graft vs Host Disease drug therapy
Graft vs Host Disease etiology
Photopheresis
Nitriles
Pyrazoles
Pyrimidines
Subjects
Details
- Language :
- English
- ISSN :
- 1873-2623
- Volume :
- 56
- Issue :
- 2
- Database :
- MEDLINE
- Journal :
- Transplantation proceedings
- Publication Type :
- Academic Journal
- Accession number :
- 38342748
- Full Text :
- https://doi.org/10.1016/j.transproceed.2023.12.021