Corticosteroid regimens for treatment of acute and chronic graft versus host disease (GvHD) after allogenic stem cell transplantation.
BACKGROUND
Corticosteroids are commonly used in treatment of acute and chronic graft-versus-host disease (GvHD). Nevertheless, there has been no systematic analysis of effects of their use on the patients' survival and quality of life.


OBJECTIVE
To compare the effect of corticosteroids in treatment of patients with GvHD and to compare the effect of different regimens of corticosteroids.


METHODS
We searched MEDLINE (up to July 2008), EMBASE (up to July 2008) and the Cochrane Controlled Trials Register (up to July 2008) to identify relevant studies. All of the references were assessed in order to identify additional trials.


METHODS
Randomized controlled trials of any language were included in the study as long as they met any of the predefined comparisons of interest. The primary outcome in question was the overall survival of the patients. Due to lack of evidence, inclusion criteria was revised during the process of the review to include studies comparing different dosage of corticosteroids.


METHODS
All derived citations and abstracts were screened by two independent review authors for relevance. For the potentially relevant trials, the full text was obtained and reviewed by two review authors independently. Two review authors completed data extraction independently. After revising the inclusion criteria, this process was retried to ensure all relevant evidence is included in the review.


RESULTS
No studies met the original inclusion criteria but two studies (four articles) met the revised inclusion criteria. As they addressed different clinical questions, meta-analysis was not performed. The outcomes of one study were in favor of efficacy of corticosteroids in inducing an earlier remission of acute GvHD, while the other study reported that early corticosteroid therapy of acute GvHD could not prevent progression of the disease to higher grades, although it was accompanied by a slightly better prognosis in the patients who responded by the fifth day of treatment.


CONCLUSIONS
There is no certain study regarding appropriate use, dose and length of therapy for acute GvHD. Further studies are needed to define the appropriate use of steroids and whether other agents are appropriate as frontline therapy.
Salmasian
Hojjat
H
Students' Scientific Research Center, Tehran University of Medical Sciences, Baradaran Soleimani Ave., Qeytarieh, Tehran, Iran, 1938833911.
Rohanizadegan
Mersedeh
M
Banihosseini
Setareh
S
Rahimi Darabad
Raheleh
R
Rabbani-Anari
Mahtab
M
Shakiba
Alia
A
Ferrara
James L M
JL
D000208:Acute Disease; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D016026:Bone Marrow Transplantation / Q000379:methods*; D002908:Chronic Disease; D006086:Graft vs Host Disease / Q000188:drug therapy* / Q000401:mortality; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods*; D006801:Humans; D008775:Methylprednisolone / Q000627:therapeutic use; D011239:Prednisolone / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic; D014184:Transplantation, Homologous
D000305:Adrenal Cortex Hormones; D011239:Prednisolone; D008775:Methylprednisolone