2017 Aug 14;38(8):649-655. doi: 10.3760/cma.j.issn.0253-2727.2017.08.001.

Pediatric acute GVHD: clinical phenotype and response to upfront steroids. vs27.6, 0 Successful treatment of malignant diseases by allogeneic hematopoietic cell transplantation (HCT) depends upon the ability to control acute graft-versus-host disease (GVHD), a complication associated with considerable morbidity and mortality.1-4  In most patients who present with acute GVHD, symptoms develop during prophylaxis with immunosuppressive medications, and systemic glucocorticoids are typically added as first-line treatment.5,6  In most patients, glucocorticoids effectively control inflammatory GVHD manifestations without the need for additional immunosuppressive agents, and treatment can eventually be withdrawn. Patients treated with these conditioning regimens were given a calcineurin inhibitor (CSP or tacrolimus) in combination with MMF.19,20  Tapering schedules of immunosuppressive agents were modified at the discretion of the attending physicians for treatment of GVHD or management of persistent or recurrent malignancy.

High-dose methylprednisolone treatment for acute graft-versus-host disease after bone marrow transplantation in adults. Patients in the short taper group received a total PRED dose of 2275 mg/m2 over 86 days, whereas those in the long taper group received 6300 mg/m2 over 147 days. National Center for Biotechnology Information, Unable to load your collection due to an error, Unable to load your delegates due to an error. There was an even distribution between donor type (related bone marrow [BM] or peripheral blood [PB] 1994 Consensus conference on acute GVHD grading. In contrast, for patients treated initially with low-dose prednisone, the typical sequence was first to increase the prednisone-equivalent dose from 1 to 2 mg/kg per day. All information is observation-only, and has not been supported by scientific studies or clinical trials unless otherwise stated. Even though comprehensive assessment of glucocorticoid-related morbidity was beyond the scope of our retrospective study, we found that patients given low-dose glucocorticoids as initial therapy had a one-third lower likelihood of hospitalization for more than 7 days compared with those given high-dose glucocorticoids.

All patients who had allogeneic HCT at the Fred Hutchinson Cancer Research Center between January 2000 and December 2005, were at least 18 years of age, and had initial treatment for acute GVHD with systemic glucocorticoids were included in this retrospective study. designed the study, extracted and analyzed data, and wrote the manuscript; P.J.M. Some reports may have incomplete information. Subsequently, 43% of patients required hospitalization for more than 7 consecutive or nonconsecutive days after beginning glucocorticoid therapy for acute GVHD.

Overall, 432 patients were hospitalized at the initiation of glucocorticoid treatment. This study suggests that the rapid administration of high-dose PRED to a cumulative dose of 2000 mg/m2 might lead to complete and prompt resolution of acute GVHD in the majority of patients and that rapid PRED taper might provide a mechanism for minimizing steroid-related morbidity. Adjusted for GVHD grade at onset of treatment (I vs IIa vs IIb vs ≥ III), gut GVHD at onset (any vs none), patient age (continuous variable), donor type (unrelated vs other), donor/recipient HLA mismatch (any vs other) and sex mismatch (female donor with male recipient vs other), conditioning intensity (myeloablative vs nonmyeloablative), use of tacrolimus as part of the GVHD prophylaxis, year of transplantation (continuous variable), concurrent use of BDP and systemic glucocorticoids, and transplantation-to-treatment interval (continuous variable). The choice of drug and the decision to taper are independent. Importantly, the incidence of chronic GVHD and survival at 6 months was similar in the 2 groups. COVID-19 is an emerging, rapidly evolving situation. Correspondence: Marco Mielcarek, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N, D1-100, Seattle, WA 98109-1024; e-mail: mielcar@fhcrc.org. title = "Prednisone therapy for acute graft-versus-host disease: Short-versus long-term treatment: A prospective randomized trial". The following additional factors were associated with hospitalization for more than 7 days: time to first GVHD therapy (OR, 0.81; 95% CI, 0.7-0.9; per week delayed), unrelated donor versus other donor (OR, 1.60; 95% CI, 1.1-2.3), and acute GVHD grade III/IV versus grade I/IIa at onset (OR, 4.94; 95% CI, 2.5-9.6). Although first described nearly 40 years ago, 1-3 chronic graft-versus-host disease (cGVHD) is still a common and often devastating consequence of allogeneic hematopoietic stem cell transplantation (HSCT) after cure of an otherwise fatal malignancy. The publication costs of this article were defrayed in part by page charge payment. The small number of patients with grades III/IV acute GVHD at onset precluded definitive conclusions for this subgroup.

Patients given low-dose treatment showed trends suggesting lower hazards of invasive fungal infection (HR, 0.59; 95% CI, 0.3-1.0) and bacteremia with Gram-positive organisms (HR, 0.78; 95% CI, 0.6-1.0), respectively, than those given standard-dose treatment (Table 3). Subgroup analyses of patients with grade IIb or greater acute GVHD and those with less than grade IIb acute GVHD at the beginning of glucocorticoid therapy did not change these conclusions. The median PRED dose required to achieve complete resolution of acute GVHD was not different between the two groups: 1300 mg/m2 for the long taper patients and 1800 mg/m2 for the short taper patients. vs29.7, 65.5 Multivariate hazards of NRM and overall survival were not significantly different between the 2 groups (P = .27 and P = .61, respectively). Van Lint MT, Uderzo C, Locasciulli A, Majolino I, Scimé R, Locatelli F, Giorgiani G, Arcese W, Iori AP, Falda M, Bosi A, Miniero R, Alessandrino P, Dini G, Rotoli B, Bacigalupo A. Theurich S, Fischmann H, Shimabukuro-Vornhagen A, Chemnitz JM, Holtick U, Scheid C, Skoetz N, von Bergwelt-Baildon M. Cochrane Database Syst Rev. The unadjusted cumulative incidence of invasive fungal infections for patients with acute GVHD treated with low-dose versus standard-dose glucocorticoids is shown in Figure 4. The corollary of this approach is that initial treatment with a lower dose of glucocorticoids will endanger patient outcomes because of undertreatment.3  A gradual taper of the dose is typically instituted once manifestations abate.6,10-12. Further investigation and formal studies of the dose-response relationships and kinetics of steroid administration may lead to improvement in the management of acute GVHD. We report the results of a controlled study in which BMT patients with moderate/severe acute graft-versus-host disease (GVHD) who responded to primary treatment with corticosteroids were prospectively randomized to short versus long taper of their steroid doses. %%EOF Please enable it to take advantage of the complete set of features! In a multivariate analysis that included adjustment for “hospitalization at the initiation of glucocorticoid treatment,” the likelihood of hospitalization for more than 7 days was reduced by 38% in the group given low-dose glucocorticoids (odds ratio [OR], 0.62; 95% CI, 0.4-0.9) compared with the group given standard-dose glucocorticoids. Systemic glucocorticoids were used for initial treatment, and decisions regarding the initial dose (prednisone-equivalent dose of 1 or 2 mg/kg per day) were made at the discretion of the attending physician. and K.A.M. 2020 Jan;55(1):165-171. doi: 10.1038/s41409-019-0651-9.

Get the latest public health information from CDC: https://www.coronavirus.gov. Acute GVHD was diagnosed and graded according to established criteria.2,25  Patients who presented with grade II acute GVHD before initial treatment were further categorized as having grade IIa manifestations (rash involving ≤ 50% of body surface area and stool volumes ≤ 1.0 L/day with or without anorexia, nausea, and vomiting and no liver involvement) or IIb manifestations (rash involving > 50% of body surface, stool volumes > 1.0 L/day, or any liver involvement) at onset.18. A retrospective analysis of therapy for acute graft-versus-host disease: initial treatment. 84 0 obj <>/Filter/FlateDecode/ID[<2911DB1AA0C2E0CF05C3CDC16B9C4642>]/Index[77 17]/Info 76 0 R/Length 56/Prev 143276/Root 78 0 R/Size 94/Type/XRef/W[1 2 1]>>stream H. Lee Moffitt Cancer Center and Research Institute, Tampa, US, during the 2019 Among patients who had initial treatment with low-dose glucocorticoids, 16% had the prednisone-equivalent dose increased from 1 mg/kg per day to 2 mg/kg per day, and an additional 7% received secondary therapy with other agents. Thirty patients with moderate/severe acute GVHD who responded by 14 days were eligible for random assignment of their steroid tapering schedule. Contribution: M.M. Overall ratings: 3.8/5 Dive into the research topics of 'Prednisone therapy for acute graft-versus-host disease: Short-versus long-term treatment: A prospective randomized trial'. USA.gov. doi: 10.1002/14651858.CD009159.pub2. However, these are only effective in around 50% of patients and cause toxic side effects. Bu indicates busulfan; Cy, cyclophosphamide; TBI, total body irradiation; and BDP, beclomethasone diproprionate. vs3, 29.7

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