|
|
 Previous Article | Table of Contents | Next Article 
A retrospective analysis of therapy for acute graft-versus-host disease:
secondary treatment
PJ Martin, G Schoch, L Fisher, V Byers, FR Appelbaum, GB McDonald, R Storb and JA Hansen
Division of Clinical Research, Fred Hutchinson Cancer Research Center,
Seattle, WA 98104.
We have reviewed results of secondary therapy in 427 patients with acute
graft-versus-host disease (GVHD) who did not have a durable satisfactory
response after primary treatment. At the beginning of secondary treatment,
320 patients (75%) had rash, 252 (59%) had liver dysfunction, and 228 (53%)
had gut dysfunction. Secondary treatment was with glucocorticoids (n =
249), cyclosporine (n = 80), antithymocyte globulin (n = 114), or
monoclonal antibody (n = 19) either singly (n = 390) or in combination (n =
37). Parameters of GVHD severity were recorded weekly, and responses were
determined according to values at the initiation of tertiary treatment or,
for patients without such treatment, using values on day 29 of secondary
treatment or the last recorded values before death, whichever occurred
first. Minimal criteria for improvement or deterioration were defined for
each organ, but no attempt was made to define liver or gut outcome if
another complication such as venocclusive disease or infectious enteritis
was present. Improvement or resolution of GVHD in the respective organ was
seen in 45% of patients with skin disease, 25% of patients with evaluable
liver disease, and in 35% of patients with evaluable gut disease. Overall
complete or partial responses were seen in 40% of patients. The highest
complete response rate with secondary therapy (23%) was seen when GVHD
recurred during the taper phase of primary glucocorticoid treatment and was
managed by increasing the dose of glucocorticoids. Multivariate analyses
were performed to identify patient, disease, or treatment factors
associated with likelihood of complete response or overall improvement. A
similar analysis was performed to identify covariates associated with time
to treatment failure (defined as initiation of tertiary therapy or death
not due to relapse of malignancy). Severe dysfunction in the skin, liver,
and gut at the beginning of treatment was associated both with a decreased
likelihood of complete response and an increased treatment failure rate.
The times to treatment failure and the proportions of patients in various
response categories were similar for primary and secondary treatment,
suggesting that the potential efficacy of new immunosuppressive agents for
treatment of acute GVHD can be assessed meaningfully in patients who have
not responded adequately to initial therapy.
Volume 77,
Issue 8,
pp. 1821-1828,
04/15/1991
Copyright © 1991 by The American Society of Hematology
 CiteULike  Connotea  Del.icio.us  Digg  Reddit  Technorati What's this?
This article has been cited by other articles:
|
|
|
|
 
S. Paczesny, O. I. Krijanovski, T. M. Braun, S. W. Choi, S. G. Clouthier, R. Kuick, D. E. Misek, K. R. Cooke, C. L. Kitko, A. Weyand, et al.
A biomarker panel for acute graft-versus-host disease
Blood,
January 8, 2009;
113(2):
273 - 278.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. W. Choi, C. L. Kitko, T. Braun, S. Paczesny, G. Yanik, S. Mineishi, O. Krijanovski, D. Jones, J. Whitfield, K. Cooke, et al.
Change in plasma tumor necrosis factor receptor 1 levels in the first week after myeloablative allogeneic transplantation correlates with severity and incidence of GVHD and survival
Blood,
August 15, 2008;
112(4):
1539 - 1542.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
D. M. Hockenbery, S. Cruickshank, T. C. Rodell, T. Gooley, F. Schuening, S. Rowley, D. David, M. Brunvand, B. Berryman, S. Abhyankar, et al.
A randomized, placebo-controlled trial of oral beclomethasone dipropionate as a prednisone-sparing therapy for gastrointestinal graft-versus-host disease
Blood,
May 15, 2007;
109(10):
4557 - 4563.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. L. MacMillan, D. Couriel, D. J. Weisdorf, G. Schwab, N. Havrilla, T. R. Fleming, S. Huang, L. Roskos, S. Slavin, R. K. Shadduck, et al.
A phase 2/3 multicenter randomized clinical trial of ABX-CBL versus ATG as secondary therapy for steroid-resistant acute graft-versus-host disease
Blood,
March 15, 2007;
109(6):
2657 - 2662.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. Bolanos-Meade, D. A. Jacobsohn, J. Margolis, A. Ogden, M. G. Wientjes, J. C. Byrd, D. M. Lucas, V. Anders, M. Phelps, M. R. Grever, et al.
Pentostatin in Steroid-Refractory Acute Graft-Versus-Host Disease
J. Clin. Oncol.,
April 20, 2005;
23(12):
2661 - 2668.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
V. T. Ho, D. Zahrieh, E. Hochberg, E. Micale, J. Levin, C. Reynolds, S. Steckel, C. Cutler, D. C. Fisher, S. J. Lee, et al.
Safety and efficacy of denileukin diftitox in patients with steroid-refractory acute graft-versus-host disease after allogeneic hematopoietic stem cell transplantation
Blood,
August 15, 2004;
104(4):
1224 - 1226.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
D. Couriel, R. Saliba, K. Hicks, C. Ippoliti, M. de Lima, C. Hosing, I. Khouri, B. Andersson, J. Gajewski, M. Donato, et al.
Tumor necrosis factor-{alpha} blockade for the treatment of acute GVHD
Blood,
August 1, 2004;
104(3):
649 - 654.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
G. Akpek, J. K. Boitnott, L. A. Lee, J. P. Hallick, M. Torbenson, D. A. Jacobsohn, S. Arai, V. Anders, and G. B. Vogelsang
Hepatitic variant of graft-versus-host disease after donor lymphocyte infusion
Blood,
December 1, 2002;
100(12):
3903 - 3907.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
I. A. Tabbara, K. Zimmerman, C. Morgan, and Z. Nahleh
Allogeneic Hematopoietic Stem Cell Transplantation: Complications and Results
Arch Intern Med,
July 22, 2002;
162(14):
1558 - 1566.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
P. A. Carpenter, F. R. Appelbaum, L. Corey, H. J. Deeg, K. Doney, T. Gooley, J. Krueger, P. Martin, S. Pavlovic, J. Sanders, et al.
A humanized non-FcR-binding anti-CD3 antibody, visilizumab, for treatment of steroid-refractory acute graft-versus-host disease
Blood,
April 15, 2002;
99(8):
2712 - 2719.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
H. J. Deeg, B. R. Blazar, B. J. Bolwell, G. D. Long, F. Schuening, J. Cunningham, R. M. Rifkin, S. Abhyankar, A. D. Briggs, R. Burt, et al.
Treatment of steroid-refractory acute graft-versus-host disease with anti-CD147 monoclonal antibody ABX-CBL
Blood,
October 1, 2001;
98(7):
2052 - 2058.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
G. Akpek, M. L. Zahurak, S. Piantadosi, J. Margolis, J. Doherty, R. Davidson, and G. B. Vogelsang
Development of a prognostic model for grading chronic graft-versus-host disease
Blood,
March 1, 2001;
97(5):
1219 - 1226.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
H. T. Greinix, B. Volc-Platzer, P. Kalhs, G. Fischer, A. Rosenmayr, F. Keil, H. Honigsmann, and R. M. Knobler
Extracorporeal photochemotherapy in the treatment of severe steroid-refractory acute graft-versus-host disease: a pilot study
Blood,
October 1, 2000;
96(7):
2426 - 2431.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
F. Locatelli, M. Zecca, R. Rondelli, F. Bonetti, G. Dini, A. Prete, C. Messina, C. Uderzo, M. Ripaldi, F. Porta, et al.
Graft versus host disease prophylaxis with low-dose cyclosporine-A reduces the risk of relapse in children with acute leukemia given HLA-identical sibling bone marrow transplantation: results of a randomized trial
Blood,
March 1, 2000;
95(5):
1572 - 1579.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
D. Przepiorka, N. A. Kernan, C. Ippoliti, E. B. Papadopoulos, S. Giralt, I. Khouri, J.-G. Lu, J. Gajewski, A. Durett, K. Cleary, et al.
Daclizumab, a humanized anti-interleukin-2 receptor alpha chain antibody, for treatment of acute graft-versus-host disease
Blood,
January 1, 2000;
95(1):
83 - 89.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
E. C. Guinan, V. A. Boussiotis, D. Neuberg, L. L. Brennan, N. Hirano, L. M. Nadler, and J. G. Gribben
Transplantation of Anergic Histoincompatible Bone Marrow Allografts
N. Engl. J. Med.,
June 3, 1999;
340(22):
1704 - 1714.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. I. Strasser, K. M. Sullivan, D. Myerson, C. L. Spurgeon, B. Storer, H. G. Schoch, C. S. Murakami, and G. B. McDonald
Cirrhosis of the Liver in Long-Term Marrow Transplant Survivors
Blood,
May 15, 1999;
93(10):
3259 - 3266.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
D. Przepiorka, G. L. Phillips, V. Ratanatharathorn, M. Cottler-Fox, L. H. Sehn, J. H. Antin, D. LeBherz, M. Awwad, J. Hope, and J. B. McClain
A Phase II Study of BTI-322, a Monoclonal Anti-CD2 Antibody, for Treatment of Steroid-Resistant Acute Graft-Versus-Host Disease
Blood,
December 1, 1998;
92(11):
4066 - 4071.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
V. Ratanatharathorn, R. A. Nash, D. Przepiorka, S. M. Devine, J. L. Klein, D. Weisdorf, J. W. Fay, A. Nademanee, J. H. Antin, N. P. Christiansen, et al.
Phase III Study Comparing Methotrexate and Tacrolimus (Prograf, FK506) With Methotrexate and Cyclosporine for Graft-Versus-Host Disease Prophylaxis After HLA-Identical Sibling Bone Marrow Transplantation
Blood,
October 1, 1998;
92(7):
2303 - 2314.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J.T. Slattery, R.A. Clift, C.D. Buckner, J. Radich, B. Storer, W.I. Bensinger, E. Soll, C. Anasetti, R. Bowden, E. Bryant, et al.
Marrow Transplantation for Chronic Myeloid Leukemia: The Influence of Plasma Busulfan Levels on the Outcome of Transplantation
Blood,
April 15, 1997;
89(8):
3055 - 3060.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S.-B. Woo, S. J. Lee, and M. M. Schubert
Graft-vs.-Host Disease
Critical Reviews in Oral Biology & Medicine,
January 1, 1997;
8(2):
201 - 216.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
N. J. Chao, G. M. Schmidt, J. C. Niland, M. D. Amylon, A. C. Dagis, G. D. Long, A. P. Nademanee, R. S. Negrin, M. R. O'Donnell, P. M. Parker, et al.
Cyclosporine, Methotrexate, and Prednisone Compared with Cyclosporine and Prednisone for Prophylaxis of Acute Graft-versus-Host Disease
N. Engl. J. Med.,
October 21, 1993;
329(17):
1225 - 1230.
[Abstract]
[Full Text]
|
|
|
|
|
