A personalized, organ-based approach to the treatment of chronic steroid-refractory graft-versus-host disease

IF 6.9 2区 医学 Q1 HEMATOLOGY
Hanaa Fatoum , Robert Zeiser , Shahrukh K. Hashmi
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引用次数: 0

Abstract

Chronic graft-versus-host-disease (cGvHD) remains the leading cause of morbidity among transplant recipients. The efficacy of second-line treatments varies widely based on many factors, including wide differences in the organ overall response-rate response and in the current era where multiple agents are approved, and optimal sequencing of drugs based on organ ORR is unknown. We aimed to evaluate outcomes based on ORRs to the most common agents for the treatment of steroid-refractory/steroid-dependent cGvHD by conducting a systematic literature review. A total of 387 studies were evaluated for the ORRs of 12 cGvHD treatments. The highest skin ORR was observed to be 77% though some agents had an acceptable ORR. Most agents had an ocular response ranging from 17 to 50% Some agents resulted in a GI ORR of ≥88%. Rituximab showed the best response for musculoskeletal-GvHD. In the case of lung-GvHD (bronchiolitis obliterans syndrome [BOS]), negligible response was observed in patients treated with various agents. No clinically meaningful responses to treatments were reported for genital-GvHD. Most GvHD trials are focused on the ORR and partial response rates (PRR). The evidence for optimal agents for each organ is limited, and therefore, our study results are striking for differences in organ-ORR yields for a clinically meaningful difference. Thus, a personalized organ-based approach to the selection of therapeutic agents in cGvHD could result in favorable outcomes.

治疗慢性类固醇难治性移植物抗宿主病的个性化、基于器官的方法
慢性移植物抗宿主病(cGvHD)仍然是移植受者发病的主要原因。二线治疗的疗效因多种因素而存在很大差异,包括器官总体反应率反应的巨大差异,以及在当前多种药物已获批准的时代,根据器官总体反应率对药物进行最佳排序的情况尚不清楚。我们旨在通过系统性文献综述,根据治疗类固醇难治性/类固醇依赖性 cGvHD 的最常用药物的 ORRs 评估疗效。共有 387 项研究评估了 12 种 cGvHD 治疗方法的 ORRs。据观察,最高的皮肤 ORR 为 77%,尽管有些药物的 ORR 可以接受。有些药物的消化道 ORR ≥88%。利妥昔单抗对肌肉骨骼-GvHD的反应最好。在肺部-血管疾病(阻塞性支气管炎综合征[BOS])方面,使用不同药物治疗的患者的反应微乎其微。在生殖器-风湿性关节炎方面,没有关于有临床意义的治疗反应的报道。大多数 GvHD 试验都侧重于 ORR 和部分应答率 (PRR)。针对每个器官的最佳药物证据有限,因此,我们的研究结果在器官 ORR 收率的差异方面具有显著的临床意义。因此,采用基于器官的个性化方法来选择治疗 cGvHD 的药物可能会带来良好的疗效。
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来源期刊
Blood Reviews
Blood Reviews 医学-血液学
CiteScore
13.80
自引率
1.40%
发文量
78
期刊介绍: Blood Reviews, a highly regarded international journal, serves as a vital information hub, offering comprehensive evaluations of clinical practices and research insights from esteemed experts. Specially commissioned, peer-reviewed articles authored by leading researchers and practitioners ensure extensive global coverage across all sub-specialties of hematology.
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