Lower Risk of Graft Versus Host Disease after Exposure to Checkpoint Inhibitors with the Use of Post-Transplant Cyclophosphamide Prophylaxis
Chantal SaberianNoha Abdel‐WahabAla AbudayyehHind RafeiJacinth JosephMay DaherStephen K. GruschkusCristina KnapeLaura WhitedAlison GulbisMegan MarcotulliGabriela RondónUday PopatRohtesh S. MehtaMarina KonoplevaBetül OranMaro OhanianFarhad RavandiGuillermo Garcia‐ManeroAmin M. AlousiNaval DaverRichard E. ChamplinAdi DiabGheath Alatrash
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Graft‐ vs ‐host disease (GVHD) is a serious complication of hematopoietic stem cell transplantation (HSCT). Indications for HSCT have greatly expanded, and more patients are undergoing HSCT today than ever before. In addition, the options for immunosuppressive therapy for both prevention and treatment of GVHD have also expanded. These changes have in turn altered the landscape of this disease. We have reviewed the current literature on this subject and presented an update on this disease with a particular emphasis on mucosal manifestations.
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Cyclophosphamide's lack of hematopoietic stem cell toxicity and its unique effects on the immune system have prompted several investigators to explore its potential for the prevention of graft-versus-host disease (GVHD). In haploidentical hematopoietic stem cell transplants, post-transplant cyclophosphamide together with standard prophylaxis reduces the incidence of GVHD to acceptable rates without the need for T cell depletion. In matched related and unrelated donor settings, cyclophosphamide alone has produced encouraging results. In particular, the low incidence of chronic GVHD is noteworthy. Here, we present a review of the current understanding of the mechanism of action of post-transplant cyclophosphamide and summarize the clinical data on its use for the prevention of GVHD.
Hematopoietic stem cell
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Purpose: To investigate the incidence, clinical manifestations, and risk factors of ocular graft-versus-host disease (GVHD) as well as the survival of the patients after allogeneic hematopoietic stem cell transplantation (HSCT). Methods: The medical records of 99 patients who visited our clinic and were screened for ocular GVHD after allogeneic HSCT were reviewed retrospectively. Subjects were divided into 2 groups depending on the occurrence of ocular GVHD on slit-lamp biomicroscopy. We compared clinical manifestations and survival between the 2 groups and analyzed the risk factors associated with the development of ocular GVHD. Results: Ocular GVHD was diagnosed in 38 patients (38.38%) at a mean of 315 days after HSCT. Out of the 38 patients who developed ocular GVHD, 22 patients (57.89%) were diagnosed with dry eye only and 16 patients (42.11%) were diagnosed with conjunctival disease. The presence of extraocular GVHD (hazard ratio (HR) 35.76, p < 0.001), the number of extraocular GVHD (HR 3.07, p < 0.001), skin GVHD (HR 2.31, p = 0.029), oral GVHD (HR 8.16, p < 0.001), and gastrointestinal tract GVHD (HR 5.00, p = 0.002) were independent risk factors of ocular GVHD. Comparisons of the survival demonstrated decreased survival of patients with conjunctival disease compared to patients without ocular GVHD and patients with dry eye only, but there was no statistically significant differences (log rank test, p = 0.208). Conclusions: Ocular GVHD is common after allogeneic HSCT. The majority of ocular GVHD occurs in the chronic stage and is associated with decreased survival. Therefore, more intensive and long-term follow-up with ophthalmic and systemic monitoring is necessary, especially in patients who have extraocular GVHD, for early recognition and proper treatment of ocular GVHD. J Korean Ophthalmol Soc 2014;55(7):969-977
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Hematopoietic stem cell
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