OBJECTIVE: The therapeutic options currently available for treating refractory graft-vs.-host disease (GVHD) are limited. Therefore, the present study evaluated the efficacy of mycophenolate mofetil (MMF) as a salvage treatment for acute and chronic GVHD in allograft patients. METHODS: Twenty-six consecutive patients with refractory acute (13 patients) or chronic (13 patients) GVHD were enrolled. The first-line treatment for all patients with acute GVHD consisted of a combination of cyclosporine A (CyA) and steroids, while the first-line treatment for chronic GVHD was steroids with or without CyA according to the risk group. MMF was added at a dose of 1.5 or 2 g daily and the steroids were tapered in the refractory cases. RESULTS: Four (30.8%) of 13 patients with refractory acute GVHD responded to MMF. When analyzing the overall results according to the type of acute GVHD, improvement was observed in four (30.8%) of 13 skin cases, four (44.4%) of nine liver cases, and two (22.9%) of nine gut cases. Ten (76.9%) of 13 patients with refractory chronic GVHD responded to MMF. The common side effects were gastrointestinal disturbance (26.9%) or infectious complications (23.1%). The estimated 2-yr survival rate for patients with acute GVHD and chronic GVHD was 33.3% and 53.9%, respectively. CONCLUSIONS: MMF would appear to be effective and safe for treating refractory chronic GVHD, yet not as effective for treating refractory acute gut GVHD. Accordingly, a prospective randomized clinical trial is warranted to assess the impact of MMF in the treatment of refractory GVHD.
OBJECTIVE: The therapeutic options currently available for treating refractory graft-vs.-host disease (GVHD) are limited. Therefore, the present study evaluated the efficacy of mycophenolate mofetil (MMF) as a salvage treatment for acute and chronic GVHD in allograft patients. METHODS: Twenty-six consecutive patients with refractory acute (13 patients) or chronic (13 patients) GVHD were enrolled. The first-line treatment for all patients with acute GVHD consisted of a combination of cyclosporine A (CyA) and steroids, while the first-line treatment for chronic GVHD was steroids with or without CyA according to the risk group. MMF was added at a dose of 1.5 or 2 g daily and the steroids were tapered in the refractory cases. RESULTS: Four (30.8%) of 13 patients with refractory acute GVHD responded to MMF. When analyzing the overall results according to the type of acute GVHD, improvement was observed in four (30.8%) of 13 skin cases, four (44.4%) of nine liver cases, and two (22.9%) of nine gut cases. Ten (76.9%) of 13 patients with refractory chronic GVHD responded to MMF. The common side effects were gastrointestinal disturbance (26.9%) or infectious complications (23.1%). The estimated 2-yr survival rate for patients with acute GVHD and chronic GVHD was 33.3% and 53.9%, respectively. CONCLUSIONS:MMF would appear to be effective and safe for treating refractory chronic GVHD, yet not as effective for treating refractory acute gut GVHD. Accordingly, a prospective randomized clinical trial is warranted to assess the impact of MMF in the treatment of refractory GVHD.
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Authors: R Zeiser; A Burchert; C Lengerke; M Verbeek; K Maas-Bauer; S K Metzelder; S Spoerl; M Ditschkowski; M Ecsedi; K Sockel; F Ayuk; S Ajib; F S de Fontbrune; I-K Na; L Penter; U Holtick; D Wolf; E Schuler; E Meyer; P Apostolova; H Bertz; R Marks; M Lübbert; R Wäsch; C Scheid; F Stölzel; R Ordemann; G Bug; G Kobbe; R Negrin; M Brune; A Spyridonidis; A Schmitt-Gräff; W van der Velden; G Huls; S Mielke; G U Grigoleit; J Kuball; R Flynn; G Ihorst; J Du; B R Blazar; R Arnold; N Kröger; J Passweg; J Halter; G Socié; D Beelen; C Peschel; A Neubauer; J Finke; J Duyster; N von Bubnoff Journal: Leukemia Date: 2015-07-31 Impact factor: 11.528
Authors: T Furlong; P Martin; M E D Flowers; F Carnevale-Schianca; R Yatscoff; T Chauncey; F R Appelbaum; H J Deeg; K Doney; R Witherspoon; B Storer; K M Sullivan; R Storb; R A Nash Journal: Bone Marrow Transplant Date: 2009-04-20 Impact factor: 5.483