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15 - Treatment guidelines for acute graft-versus-host disease

Published online by Cambridge University Press:  05 November 2013

Joseph H. Antin  and
Deborah Yolin Raley
Joseph H. Antin
Affiliation:
Dana-Farber Cancer Institute, Boston
Deborah Yolin Raley
Affiliation:
Dana-Farber Cancer Institute, Boston
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Summary

Steroids ± calcineurin inhibitor

All other therapies areinvestigational at this time and no comparative data are available.

  • Therapy is effective 30–60% of the time.

  • Typically, therapy needs to be maintained until manifestations are completely resolved; however, be careful of the risk of opportunistic infections and EBV lymphoproliferative disorders that are associated with increased immunosuppression.

  • If GVHD develops after T-cell-depleted HSCT, CSA or tacrolimus are useful additions.

    • Steroids

    Methylprednisolone 0.5 to 2mg/kg/day. The most common dose is 1 to 2 mg/kg day in grade II to IVGVHD.

  • Conversion: Hydrocortisone (1×), prednisone (4×), Solu-Medrol® (5×), Decadron (20×). For example, a patient on 100 mg of Solu-Medrol would convert to 80 mg of prednisone.

  • There is no standard method to tapering steroids once symptoms improve. A reasonable approach is to taper by 10% of original dose per week in the absence of GVHD symptoms and after GVHD has been controlled for about 1 month.

    • Type
    Chapter
    Information
    Manual of Stem Cell and Bone Marrow Transplantation
    , pp. 64 - 78
    Publisher: Cambridge University Press
    Print publication year: 2013

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    References

    Basara, N, Blau, WI, Romer, E, et al. Mycophenolate mofetil for the treatment of acute and chronic GVHD in bone marrow transplant patients. Bone Marrow Transplant 1998; 22: 61–5.CrossRefGoogle ScholarPubMed
    Delgado, J, Thompson, K, Russell, N, et al. Results of alemtuzumab-based reduced-intensity allogeneic transplantation for chronic lymphocytic leukemia: British Society of Blood and Marrow Transplantation. Blood 2006; 107: 1724–30.CrossRefGoogle ScholarPubMed
    Kubiak, DW, Koo, S, Hammond, SP et al. Safety of posaconazole and sirolimus coadministration in allogeneic hematopoietic stem cell transplants. Biol Blood Marrow Transplant 2012; 18: 1462–5.CrossRefGoogle ScholarPubMed
    MacMillan, ML, Weisdorf, DJ, Davies, SM, et al. Early antithymocyte globulin therapy improves survival in patients with steroid-resistant acute graft-versus-host disease. Biol Blood Marrow Transplant 2002; 8: 40–6.CrossRefGoogle ScholarPubMed
    Nevill, TJ, Tirgan, MH, Deeg, HJ, et al. Influence of post-methotrexate folinic acid rescue on regimen-related toxicity and graft-versus-host disease after allogeneic bone marrow transplantation. Bone Marrow Transplant 1992; 9: 349–54.Google ScholarPubMed
    Vogelsang, GB. Advances in the treatment of graft-versus-host disease. Leukemia 2000; 14: 509–10.CrossRefGoogle ScholarPubMed

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