%0 Journal Article
%T Retrospective single center analysis of outcome, risk factors and therapy in steroid refractory graft-versus-host disease after allogeneic hematopoietic cell transplantation
%J -
%D 2019
%R https://doi.org/10.1038/s41409-019-0544-y
%X Acute and chronic graft-vs.-host disease (aGvHD and cGvHD) are major complications after allogeneic hematopoietic cell transplantation (HCT) leading to substantial morbidity and mortality. This retrospective single-center study analyzes incidence, therapy, and outcome of GvHD in n£¿=£¿721 patients ¡Ý18 years having received allogeneic HCT 2004¨C2013 with a special focus on steroid refractory GvHD. Acute (n£¿=£¿355/49.2%) and chronic (n£¿=£¿269/37.3%) GvHD were mainly treated by steroids in first-line therapy. The proportion of steroid refractory aGvHD and cGvHD was 35.7% and 31.4%, respectively. As there is no standard therapy for steroid refractory GvHD, a range of different agents was used. In aGvHD, the overall response rate (ORR) of steroid refractory GvHD to second-line treatment was 27.4%. Mycophenolate mofetil (MMF) and mTOR inhibitors led to superior response rates (ORR 50.0% and 53.3%, respectively). In steroid refractory cGvHD therapy, ORR was 44.4%. Use of calcineurin inhibitors (CNI; n£¿=£¿11/45.5%), MMF (n£¿=£¿18/50.0%), mTOR inhibitors (n£¿=£¿10/60.0%), and extracorporeal photophoresis (ECP; n£¿=£¿16/56.3%) showed ORR above average. Targeted therapies lead to responses in 7.7% (n£¿=£¿13). This data may help to improve the design of future prospective clinical studies in GvHD
%U https://www.nature.com/articles/s41409-019-0544-y