title: First- and second-line systemic treatment of acute graft-versus-host disease: recommendations of the American Society of Blood and Marrow Transplantation.
abstract: Despite prophylaxis with immunosuppressive agents or a variety of other approaches, many patients suffer from acute graft-versus-host disease (aGVHD) after allogeneic hematopoietic cell transplantation. Although consensus has emerged supporting the use of high-dose methylprednisolone or prednisone for initial treatment of aGVHD, practices differ among centers with respect to the initial glucocorticoid dose, the use of additional immunosuppressive agents, and the approach to withdrawal of treatment after initial improvement. Despite many studies, practices vary considerably with respect to the selection of agents for treatment of glucocorticoid-resistant or refractory GVHD. Investigators and clinicians have recognized the lack of progress and lamented the absence of an accepted standard of care for secondary treatment of aGVHD. The American Society of Blood and Marrow Transplantation has developed recommendations for treatment of aGVHD to be considered by care providers, based on a comprehensive and critical review of published reports. Because the literature provides little basis for a definitive guideline, this review also provides a framework for the interpretation of previous results and the design of future studies.
authors.affiliation: Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA 98109, USA. pmartin@fhcrc.org
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Martin
authors.forename: J Douglas
authors.initials: JD
authors.lastname: Rizzo
authors.forename: John R
authors.initials: JR
authors.lastname: Wingard
authors.forename: Karen
authors.initials: K
authors.lastname: Ballen
authors.forename: Peter T
authors.initials: PT
authors.lastname: Curtin
authors.forename: Corey
authors.initials: C
authors.lastname: Cutler
authors.forename: Mark R
authors.initials: MR
authors.lastname: Litzow
authors.forename: Yago
authors.initials: Y
authors.lastname: Nieto
authors.forename: Bipin N
authors.initials: BN
authors.lastname: Savani
authors.forename: Jeffrey R
authors.initials: JR
authors.lastname: Schriber
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Shaughnessy
authors.forename: Donna A
authors.initials: DA
authors.lastname: Wall
authors.forename: Paul A
authors.initials: PA
authors.lastname: Carpenter
mesh_terms: D005938:Glucocorticoids / Q000008:administration & dosage; D006086:Graft vs Host Disease / Q000188:drug therapy* / Q000209:etiology; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008775:Methylprednisolone / Q000008:administration & dosage; D011241:Prednisone / Q000008:administration & dosage; D019172:Transplantation Conditioning / Q000009:adverse effects / Q000379:methods
chemical_list: D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D011241:Prednisone; D008775:Methylprednisolone