[Acute graft-versus-host disease therapy: Which third line treatment after steroids and ruxolitinib? (SFGM-TC)].

IF 0.8
Tereza Coman, Fabio Andreozzi, Jaques-Olivier Bay, Jérôme Cornillon, Thierry Guillaume, Fati Hamzy, Laetitia Souchet, Pascal Turlure, Ambroise Marçais, François Dachy, Yves Beguin, Claude Eric Bulabois, Sanae Daghri, Anne Huynh, Leonardo Magro, Yves Chalandon
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Abstract

Acute graft-versus-host disease (GVHDa) is one of the leading causes of morbidity and mortality after allogeneic hematopoietic stem cell transplant (HSCT) patients. While the first-line consensus treatment has been based on systemic corticosteroid therapy for many years, ruxolitinib has recently been approved and has become the standard second-line treatment. Nevertheless, the effectiveness of ruxolitinib remains limited to 40 % of cortico-resistant patients, raising the crucial question of selecting a third-line treatment. Among the therapeutic modalities described, this workshop selected fecal microbiota transplantation (FMT), mesenchymal stromal cells (MSC) injection, and extracorporeal photopheresis (ECP) as the most promising or with a benefit/risk balance that favors their prescription at this stage. The workshop also highlighted the importance of research aimed at identifying markers or score calculations that guide toward a risk-adapted approach as early as possible. To date, aside from calprotectin, no marker or score is routinely used, but all are the subject of intense research. Finally, measures associated with specific treatment remain crucial, and new developments in dietary contributions, infection prophylaxis, and tissue regeneration are also addressed.

急性移植物抗宿主病治疗:在类固醇和鲁索利替尼之后,哪一种三线治疗?(SFGM-TC)]。
急性移植物抗宿主病(GVHDa)是异体造血干细胞移植(HSCT)患者发病和死亡的主要原因之一。虽然多年来一线共识治疗一直是基于全身皮质类固醇治疗,但鲁索利替尼最近已被批准并已成为标准的二线治疗。然而,ruxolitinib的有效性仍然局限于40%的皮质耐药患者,这就提出了选择三线治疗的关键问题。在所描述的治疗方式中,本次研讨会选择了粪便微生物群移植(FMT)、间充质基质细胞(MSC)注射和体外光造血(ECP)作为最有希望的或在现阶段有利/风险平衡的治疗方式。研讨会还强调了旨在确定标记或分数计算的研究的重要性,这些标记或分数计算可以引导人们尽早采用适应风险的方法。到目前为止,除了钙保护蛋白,没有常规使用标记或评分,但所有这些都是深入研究的主题。最后,与特定治疗相关的措施仍然至关重要,并且还讨论了饮食贡献,感染预防和组织再生的新进展。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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