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Peyraga G, Lizee T, Gustin P, Clement-Colmou K, Di Bartolo C, Supiot S, Mahe MA, François S, Mege M. Treatment of cutaneous and/or soft tissue manifestations of corticosteroids refractory chronic graft versus host disease (cGVHD) by a total nodal irradiation (TNI). Clin Transplant 2017; 31. [PMID: 28181304 DOI: 10.1111/ctr.12923] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2017] [Indexed: 12/01/2022]
Abstract
The management of corticosteroids refractory chronic graft versus host disease (cGVHD) remains controversial. Retrospective analysis of patients treated at the Integrated Center of Oncology by total nodal irradiation (TNI) was performed to evaluate its therapy potency. TNI delivers a dose of 1 Gy in a single session. The delimitation of the fields is clinical (upper limit: external auditory meatus; lower limit: mid-femur). No pre-therapeutic dosimetry scanner was necessary. Evaluation of the efficacy was by clinical measures at 6 months after the treatment. Twelve patients were treated by TNI between January 2010 and December 2013. TNI was used in second-line treatment or beyond. The median time between allograft and TNI was 31.2 months, and the median time between the first manifestations of cGVHD and TNI was about 24.2 months. Of the 12 patients, nine had a clinical response at 6 months (75%), including five complete clinical responses (41.6%). Five patients could benefit from a reduction of corticosteroid doses. Three patients had hematologic toxicity. TNI could be considered as an option for the treatment of a cutaneous and/or soft tissues corticosteroids refractory cGVHD. However, prospective randomized and double-blind trials remain essential to answer the questions about TNI safety and effectiveness.
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Affiliation(s)
- Guillaume Peyraga
- Department of Radiotherapy, Integrated Center of Oncology, ICO Paul Papin, Angers, France
| | - Thibaut Lizee
- Department of Radiotherapy, Integrated Center of Oncology, ICO Paul Papin, Angers, France
| | - Pierre Gustin
- Department of Radiotherapy, Integrated Center of Oncology, ICO Paul Papin, Angers, France
| | - Karen Clement-Colmou
- Department of Radiotherapy, Integrated Center of Oncology, ICO René Gauducheau, Saint-Herblain, France
| | - Christelle Di Bartolo
- Department of Medical Physics, Integrated Center of Oncology, ICO Paul Papin, Angers, France
| | - Stephane Supiot
- Department of Radiotherapy, Integrated Center of Oncology, ICO René Gauducheau, Saint-Herblain, France
| | - Marc-Andre Mahe
- Department of Radiotherapy, Integrated Center of Oncology, ICO René Gauducheau, Saint-Herblain, France
| | - Sylvie François
- Department of Blood Diseases, University Hospital of Angers, Angers, France
| | - Martine Mege
- Department of Radiotherapy, Integrated Center of Oncology, ICO Paul Papin, Angers, France
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Grønningsæter IS, Tsykunova G, Lilleeng K, Ahmed AB, Bruserud Ø, Reikvam H. Bronchiolitis obliterans syndrome in adults after allogeneic stem cell transplantation-pathophysiology, diagnostics and treatment. Expert Rev Clin Immunol 2017; 13:553-569. [DOI: 10.1080/1744666x.2017.1279053] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Ida Sofie Grønningsæter
- Department of Medicine, Hematology, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Galina Tsykunova
- Department of Medicine, Hematology, Haukeland University Hospital, Bergen, Norway
| | - Kyrre Lilleeng
- Department of Medicine, Hematology, Haukeland University Hospital, Bergen, Norway
| | - Aymen Bushra Ahmed
- Department of Medicine, Hematology, Haukeland University Hospital, Bergen, Norway
| | - Øystein Bruserud
- Department of Medicine, Hematology, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
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Hautmann AH, Wolff D, Hilgendorf I, Fehn U, Edinger M, Hoffmann P, Herr W, Kölbl O, Holler B, Sporrer D, Holler E, Hautmann MG. Total nodal irradiation in patients with severe treatment-refractory chronic graft-versus-host disease after allogeneic stem cell transplantation: Response rates and immunomodulatory effects. Radiother Oncol 2015; 116:287-93. [PMID: 26255761 DOI: 10.1016/j.radonc.2015.07.035] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2015] [Revised: 07/13/2015] [Accepted: 07/26/2015] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND PURPOSE The use of total nodal irradiation (TNI) has been reported as an immunomodulatory therapy for different diseases including chronic graft-versus-host disease (cGVHD). MATERIAL AND METHODS We retrospectively analyzed 13 patients with treatment-refractory cGVHD receiving TNI with 1×1Gy from 2001 to 2014. In 10 of 13 patients immunomodulatory effects of TNI were measured. RESULTS At time of TNI all patients had severe cGVHD (involving the skin: n=12), fascia (n=6), oral mucosa (n=8), eye (n=8), and lung (n=5). Nine of 13 patients had corticosteroid-refractory cGVHD. In 7 of 13 patients (54%) a partial response (PR) could be achieved. In 3 patients (23%) cGVHD manifestations remained stable, 2 patients progressed. One patient was not evaluable due to follow-up <1 month. At 3 months after TNI, best responses could be achieved in skin, and oral involvement including steroid sparing activity. TNI was well tolerated with adverse effects limited to reversible thrombocytopenia and neutropenia. Immunomodulatory effects on peripheral blood cells could be demonstrated including an increase of CD4+ T cells in the group of responders. CONCLUSIONS TNI represents an effective immunomodulating therapy in treatment-refractory cGVHD.
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Affiliation(s)
- Anke H Hautmann
- Department of Internal Medicine III (Hematology and Oncology), University Medical Center of Regensburg, Germany.
| | - Daniel Wolff
- Department of Internal Medicine III (Hematology and Oncology), University Medical Center of Regensburg, Germany
| | - Inken Hilgendorf
- Department of Internal Medicine (Hematology and Oncology), University Hospital of Rostock, Germany
| | - Ute Fehn
- Department of Internal Medicine III (Hematology and Oncology), University Medical Center of Regensburg, Germany
| | - Matthias Edinger
- Department of Internal Medicine III (Hematology and Oncology), University Medical Center of Regensburg, Germany
| | - Petra Hoffmann
- Department of Internal Medicine III (Hematology and Oncology), University Medical Center of Regensburg, Germany
| | - Wolfgang Herr
- Department of Internal Medicine III (Hematology and Oncology), University Medical Center of Regensburg, Germany
| | - Oliver Kölbl
- Department of Radiotherapy, University Medical Center of Regensburg, Germany
| | - Barbara Holler
- Department of Internal Medicine III (Hematology and Oncology), University Medical Center of Regensburg, Germany
| | - Daniela Sporrer
- Department of Internal Medicine III (Hematology and Oncology), University Medical Center of Regensburg, Germany
| | - Ernst Holler
- Department of Internal Medicine III (Hematology and Oncology), University Medical Center of Regensburg, Germany
| | - Matthias G Hautmann
- Department of Radiotherapy, University Medical Center of Regensburg, Germany
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Salvage therapy with everolimus reduces the severity of treatment-refractory chronic GVHD without impairing disease control: a dual center retrospective analysis. Bone Marrow Transplant 2014; 49:1412-8. [PMID: 25089598 DOI: 10.1038/bmt.2014.170] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Revised: 06/13/2014] [Accepted: 06/17/2014] [Indexed: 11/08/2022]
Abstract
Chronic GVHD (cGVHD) remains the most important cause of late non-relapse mortality post allogeneic hematopoietic SCT (HSCT). Although first-line treatment of cGVHD with steroids is well established, evidence for second-line treatment remains limited. Here, we report a dual center retrospective analysis of the off-label salvage treatment of steroid-refractory cGVHD with everolimus. Out of 80 patients with a median age of 50 (17-70) years, 14 (17%) suffered from mild, 39 (49%) from moderate and 27 (34%) from severe cGVHD. At the final analysis, median follow-up after introduction of everolimus was 724 (14-2205) days. Thirty-four patients (43%) required the addition of further immunosuppression during everolimus-based therapy. Global NIH Severity Score improved in 34 patients (43%), remained stable in 37 patients (46%) and worsened in 9 patients (11%). The total sum of Global NIH Severity Scores in all patients assessable was significantly reduced after treatment with everolimus (P<0.0001). Most frequent grade 3/4 toxicities included infections (n=30) and thrombocytopenia (n=15). There was a single case of relapse. Everolimus-based salvage treatment of refractory cGVHD results in significant improvement of the NIH Severity Score without impairing control of the malignant disease. Finally, these preliminary results demand further verification in prospective trials.
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Jachiet M, de Masson A, Peffault de Latour R, Rybojad M, Robin M, Bourhis JH, Xhaard A, Dhedin N, Sicre de Fontbrune F, Suarez F, Barete S, Parquet N, Nguyen S, Ades L, Rubio MT, Wittnebel S, Bagot M, Socié G, Bouaziz JD. Skin ulcers related to chronic graft-versus-host disease: clinical findings and associated morbidity. Br J Dermatol 2014; 171:63-8. [DOI: 10.1111/bjd.12828] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2014] [Indexed: 11/29/2022]
Affiliation(s)
- M. Jachiet
- Department of Dermatology; AP-HP; Université Paris VII Sorbonne Paris Cité; and Hôpital Saint Louis; Paris France
| | - A. de Masson
- Department of Dermatology; AP-HP; Université Paris VII Sorbonne Paris Cité; and Hôpital Saint Louis; Paris France
| | - R. Peffault de Latour
- Department of Haematology; AP-HP; Université Paris VII Sorbonne Paris Cité; and Hôpital Saint Louis; Paris France
| | - M. Rybojad
- Department of Dermatology; AP-HP; Université Paris VII Sorbonne Paris Cité; and Hôpital Saint Louis; Paris France
| | - M. Robin
- Department of Haematology; AP-HP; Université Paris VII Sorbonne Paris Cité; and Hôpital Saint Louis; Paris France
| | - J.-H. Bourhis
- Department of Haematology; AP-HP; Institut Gustave Roussy; Villejuif France
| | - A. Xhaard
- Department of Haematology; AP-HP; Université Paris VII Sorbonne Paris Cité; and Hôpital Saint Louis; Paris France
| | - N. Dhedin
- Department of Haematology; AP-HP; Université Paris VII Sorbonne Paris Cité; and Hôpital Saint Louis; Paris France
| | - F. Sicre de Fontbrune
- Department of Haematology; AP-HP; Université Paris VII Sorbonne Paris Cité; and Hôpital Saint Louis; Paris France
| | - F. Suarez
- Department of Haematology; AP-HP; Hôpital Necker; Paris France
| | - S. Barete
- Department of Dermatology; AP-HP; Hôpital Pitié Salpêtrière; Paris France
| | - N. Parquet
- Department of Haematology; AP-HP; Université Paris VII Sorbonne Paris Cité; and Hôpital Saint Louis; Paris France
| | - S. Nguyen
- Department of Haematology; AP-HP; Hôpital Pitié Salpêtrière; Paris France
| | - L. Ades
- Departments of Haematology; AP-HP; Hôpital Avicenne; Bobigny France
| | - M.-T. Rubio
- Department of Haematology; AP-HP; Hôpital Saint Antoine; Paris France
| | - S. Wittnebel
- Department of Haematology; AP-HP; Institut Gustave Roussy; Villejuif France
| | - M. Bagot
- Department of Dermatology; AP-HP; Université Paris VII Sorbonne Paris Cité; and Hôpital Saint Louis; Paris France
| | - G. Socié
- Department of Haematology; AP-HP; Université Paris VII Sorbonne Paris Cité; and Hôpital Saint Louis; Paris France
| | - J.-D. Bouaziz
- Department of Dermatology; AP-HP; Université Paris VII Sorbonne Paris Cité; and Hôpital Saint Louis; Paris France
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Affiliation(s)
- Inken Hilgendorf
- University Medicine of Rostock, Department of Hematology, Oncology and Palliative Care, Ernst-Heydemann-Strasse 6, Rostock, D-18055, Germany
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