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Steroid-refractory chronic graft-versus-host disease: treatment options and patient management

2021; Springer Nature; Volume: 56; Issue: 9 Linguagem: Inglês

10.1038/s41409-021-01389-5

1476-5365

Daniel Wolff, Giancarlo Fatobene, Vanderson Rocha, Nicolaus Kröger, Mary E.D. Flowers,

Immunotherapy and Immune Responses

Abstract Chronic graft-versus-host disease (cGVHD) is one of the major causes of late mortality after allogenic hematopoietic stem cell transplantation. Moderate-to-severe cGVHD is associated with poor health-related quality of life and substantial disease burden. While corticosteroids with or without calcineurin inhibitors comprise the first-line treatment option, the prognosis for patients with steroid-refractory cGVHD (SR-cGVHD) remains poor. The mechanisms underlying steroid resistance are unclear, and there are no standard second-line treatment guidelines for patients with SR-cGVHD. In this review, we provide an overview on current treatment options of cGVHD and use a series of theoretical case studies to elucidate the rationale of choices of second- and third-line treatment options for patients with SR-cGVHD based on individual patient profiles.