Publication details

Successful treatment of steroid-refractory hepatitic variant of liver graft-vs-host disease with pulse cyclophosphamide

Authors

MAYER Jiří KREJČÍ Marta POSPÍŠIL Zdeněk DOUBEK Michael JANÍKOVÁ Andrea ŽÁČKOVÁ Daniela RÁČIL Zdeněk ŠMARDOVÁ Lenka NAVRÁTIL Milan KAMELANDER Jan

Year of publication 2009
Type Article in Periodical
Magazine / Source Experimental Hematology
MU Faculty or unit

Faculty of Medicine

Citation
Doi http://dx.doi.org/10.1016/j.exphem.2009.03.006
Field Oncology and hematology
Keywords STEM-CELL TRANSPLANTATION; BONE-MARROW TRANSPLANTATION; DONOR LYMPHOCYTE INFUSION; ANTI-THYMOCYTE GLOBULIN; ACUTE GVHD; RETROSPECTIVE ANALYSIS; THERAPY; BLOOD
Description Objective. Corticosteroid-resistant graft-vs-host disease (GVHD) is difficult to manage and is associated with high morbidity and mortality. No standard treatment exists. We have previously seen good results with pulse cyclophosphamide (Cy) in the treatment of liver GVHD in contrast to gastrointestinal GVHD, and here we report results of pulse Cy protocol in the treatment of steroid-refractory hepatitic variant of liver GVHD, with no association to the gut. Materials and Methods. Cy was infused at a dose of 1,000 mg/m(2). Twenty-nine cyclophosphamide administrations were given to 21 patients. Median time of GVHD onset and Cy administration after transplantation, or donor lymphocyte infusion, were 58 and 69 days, respectively. Results. Eleven patients (52%) achieved complete remission and 6 patients (29%) achieved partial remission. Four patients (19%) did not respond, however, their condition stabilized and, upon additional therapy, three achieved partial remission and one complete remission. Overall survival of all 21 patients is 86%, with median and maximal follow-up of 33 and 81 months, respectively. Toxicity was mild and easily manageable without influencing chimerism or disease status. Conclusions. Pulse Cy seems to be an effective treatment for steroid-refractory hepatitic variant of liver GVHD with a good toxicity profile, which may favor its use instead of drugs with more pronounced immunosuppressive effects.
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