Treatment options in steroid-refractory acute graft-versus-host disease following hematopoietic stem cell transplantation.
OBJECTIVE
To evaluate the treatment options in steroid-refractory acute graft-versus-host disease (GVHD) following hematopoietic stem cell transplantation.


METHODS
Literature was obtained by searching MEDLINE (1966-May 2007) and EMBASE (1980-May 2007).


METHODS
All pertinent clinical trials, retrospective studies, case reports, and compassionate use studies were identified and evaluated for safety and efficacy of the pharmacologic agents.


RESULTS
Steroid-refractory acute GVHD is associated with high rates of morbidity and mortality. Although various pharmacologic agents have been studied in the treatment of steroid-refractory acute GVHD, no treatments have been established as a salvage therapy. Preliminary data on different pharmacologic agents have been identified and evaluated for their efficacy and tolerability in the treatment of steroid-refractory acute GVHD. The effects of the pharmacologic agents varied significantly among patients: severity of the disease, involvement of different organs, and the patient's age seem to be the major factors that affect an individual's response to drug therapy. In addition, the treatments are further challenged by the high incidence of potentially fatal opportunistic infections that occur during the therapy.


CONCLUSIONS
Selection of pharmacologic agents for the treatment of steroid-refractory acute GVHD should be based on the target organs, adverse drug reactions, and economic factors. Further studies with larger sample sizes are warranted to better understand the roles of these agents in the treatment of steroid-refractory acute GVHD.
Department of Pharmacy, The Mount Sinai Medical Center, New York, NY, USA. Sarasound@aol.com
Sara S
SS
Kim
D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D000961:Antilymphocyte Serum / Q000627:therapeutic use; D003520:Cyclophosphamide / Q000627:therapeutic use; D004167:Diphtheria Toxin / Q000627:therapeutic use; D004351:Drug Resistance; D000068800:Etanercept; D006086:Graft vs Host Disease / Q000188:drug therapy* / Q000209:etiology; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D007074:Immunoglobulin G / Q000627:therapeutic use; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007376:Interleukin-2 / Q000627:therapeutic use; D015649:Pentostatin / Q000627:therapeutic use; D018124:Receptors, Tumor Necrosis Factor / Q000627:therapeutic use; D011993:Recombinant Fusion Proteins / Q000627:therapeutic use; D020123:Sirolimus / Q000627:therapeutic use; D013256:Steroids / Q000627:therapeutic use
D000911:Antibodies, Monoclonal; D000961:Antilymphocyte Serum; D004167:Diphtheria Toxin; D007074:Immunoglobulin G; D007166:Immunosuppressive Agents; D007376:Interleukin-2; D018124:Receptors, Tumor Necrosis Factor; D011993:Recombinant Fusion Proteins; D013256:Steroids; C078456:denileukin diftitox; D015649:Pentostatin; D003520:Cyclophosphamide; D000068800:Etanercept; D020123:Sirolimus