A real life use of ruxolitinib in patients with acute and chronic graft versus host disease refractory to corticosteroid treatment in Latin American patients.
Allogeneic hematopoietic transplantation
Extracorporeal photopheresis
Graft-versus-host disease
Ruxolitinib
Journal
Hematology, transfusion and cell therapy
ISSN: 2531-1387
Titre abrégé: Hematol Transfus Cell Ther
Pays: Brazil
ID NLM: 101725732
Informations de publication
Date de publication:
Historique:
received:
20
05
2019
revised:
21
04
2020
accepted:
02
06
2020
pubmed:
8
10
2020
medline:
8
10
2020
entrez:
7
10
2020
Statut:
ppublish
Résumé
Graft-versus-host disease (GVHD) is a serious complication in allogeneic transplantation. The first-line treatment is high doses of corticosteroids. In the absence of response to corticosteroids, several immunosuppressive drugs can be used, but they entail an elevated risk of severe infections. Added to this, there are patients who do not improve on any immunosuppressive treatment, with subsequent deteriorated quality of life and high mortality. Ruxolitinib has been shown to induce responses in refractory patients. In this study we have presented our real-life experience. A retrospective analysis was performed on patients with severe GVHD refractory to corticosteroids. Demographic, previous treatment, response and mortality data were collected. Since 2014, seventeen patients with GVHD were treated with ruxolitinib due to refractoriness to corticosteroids and immunosuppressants and a few to extracorporeal photopheresis, 8 with acute GVHD (1 pulmonary, 4 cutaneous grade IV and 3 digestive grade IV) and 9 with chronic GHVD (5 cutaneous sclerodermiform, 2 pulmonary and 1 multisystemic). The overall response to ruxolitinib treatment for acute GVHD was 80%, 40% with partial response and 40% with complete remission. Global response in chronic GVHD was 79%. The GVHD mortality was only seen in acute disease and was 40%. Causes of mortality in those patients were severe viral pneumonia, post-transplantation hemophagocytic syndrome and meningeal GVHD refractory to ruxolitinib. In our series, the use of ruxolitinib as a rescue strategy in acute or chronic GVHD was satisfactory. Ruxolitinib treatment in patients with a very poor prognosis showed encouraging results. However, the GVHD mortality remains high in refractory patients, showing that better therapeutic strategies are needed.
Identifiants
pubmed: 33023864
pii: S2531-1379(20)30117-6
doi: 10.1016/j.htct.2020.06.015
pmc: PMC8446249
pii:
doi:
Types de publication
Journal Article
Langues
eng
Pagination
303-308Informations de copyright
Copyright © 2020 Associação Brasileira de Hematologia, Hemoterapia e Terapia Celular. Published by Elsevier España, S.L.U. All rights reserved.
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