Pentostatin Therapy for Steroid-Refractory Acute Graft Versus Host Disease: Identifying Those Who May Benefit

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 3136-3136
Author(s):  
Brittany Knick Ragon ◽  
Alison M Gulbis ◽  
Rima M Saliba ◽  
Julianne Chen ◽  
Gabriela Rondon ◽  
...  
Keyword(s):  
Partial Response ◽  
Graft Versus Host Disease ◽  
Term Survival ◽  
Graft Versus Host ◽  
Baseline Characteristics ◽  
Third Line ◽  
Steroid Refractory ◽  
Acute Graft

Abstract Patients with steroid-refractory acute graft versus host disease (aGVHD) have dismal outcomes. Historically, anti-thymocyte globulin has been used in this setting with prior reports demonstrating that even when patients respond, long-term survival occurs in only 5% of patients (Arai et al, 2012). Unfortunately, no therapy has been shown to improve outcomes for this high-risk group. Pentostatin, a potent adenosine deaminase inhibitor, was previously tested in a phase 1/ 2 study in steroid-refractory aGVHD and demonstrated an overall survival (OS) of 25% with a median follow-up of < 3 months (m). We performed a retrospective review of patients receiving pentostatin for steroid-refractory aGVHD with the goal of characterizing long-term outcomes. Methods: All patients transplanted at MD Anderson Cancer Center from January, 2006 to December, 2014 who received at least one dose of pentostatin for steroid-refractory aGVHD were included in this analysis. Pentostatin was dosed at 1.5 mg/m2 on days 1-3 and repeated every two weeks as indicated. Patients who received the drug as GVHD prophylaxis, upfront therapy, beyond third-line, for classic chronic GVHD or following relapse were excluded. Primary endpoints included day 28 response and OS. Results: A total of 60 patients received pentostatin as second (n=22) or third line (n=38) treatment for steroid-refractory aGVHD. The median age was 52 years (range, 2-70). First dose of pentostatin was administered at a median 69 days post-transplant (27-595) with a median of 3 doses provided (range, 1-9). A majority of patients had steroid-refractory lower GI (78%) and/or liver (43%) GVHD. Baseline characteristics described in table 1. The median time from initiation of steroids to pentostatin was 15 days (range, 4-172). OS at 18 m after pentostatin initiation was 21%, with median follow-up of 19 m (range, 7-77).A total of 22 (37%) patients died before day 28 and were considered non-responders. Day 28 response rate was 33% with 20 patients achieving a complete (n=11) or partial response (n=9). Pentostatin administration <10 days following initiation of steroid was the only predictor for day 28 response (HR 2.2, 95% CI 1.2-4.3, p=0.02). The median survival was 25 and 341 days in non-responders and responders, respectively. Landmark analysis starting on day 29 after pentostatin is shown in figure 1. Predictors for OS on multivariate analysis at 18 m included: day 28 complete/partial response (CR/PR) as a time dependent variable (HR 0.3, 95% CI 0.1-0.7, p=0.005), liver GVHD (HR 2.2, 95% CI 1.2-4.1, p=0.007), and age >60 (HR 1.9, 95% CI 0.99-3.6, p=0.05). Within our analysis, patients destined for early mortality within 30 days of pentostatin exhibited all these features: liver GVHD, receipt of pentostatin >100 days from transplant, and age >60, with an OS of 35% at 30 days compared to 72% in the absence of these features (p=0.001). Conclusions: Patients with steroid refractory aGVHD have dismal outcomes. However, long-term survival does occur, especially when additional therapy is administered promptly. Novel strategies to identify patients who are destined to fail upfront therapies are likely to improve outcomes. We identified that earlier dosing of pentostatin after recognition of steroid refractoriness improved response rates. Further, patients without liver GVHD and who were ≤60 had better OS, identifying those who will benefit most from this therapy. Conversely, pentostatin should be avoided in patients >60 with liver GVHD as these patients had extremely high mortality with two-thirds dying by day 30. Table 1. Baseline characteristics at pentostatin initiation. Variable Patients (N=60) Preparative Regimen Intensity  Non-myeloablative (%) 22 (37)  Ablative (%) 38 (63) Overall GVHD Grade  2 (%) 11 (18)  3 (%) 21 (35)  4 (%) 28 (47) Skin GVHD Stage  0 (%) 48 (80)  1 (%) 4 (7)  2 (%) 5 (8)  3 (%) 3 (5) Lower GI GVHD Stage  0 (%) 12 (20)  1 (%) 10 (17)  2 (%) 6 (10)  3 (%) 11 (18)  4 (%) 20 (33)  Unknown (%) 1 (2) Liver GVHD Stage  0 (%) 33 (55)  1 (%) 4 (7)  2 (%) 9 (15)  3 (%) 6 (10)  4 (%) 7 (11)  Unknown (%) 1 (2) Number of GVHD sites  1 (%) 40 (67)  2 (%) 15 (25)  ≥3 (%) 5 (8) Day 28 Response  CR (%) 11 (18)  PR (%) 9 (15)  No Response (%) 11 (18)  GVHD Progression (%) 5 (9)  Died by Day 28 (%) 22 (37)  Progression of Malignancy (%) 2 (3) Figure 1. OS, starting at day 29, stratified by response. Figure 1. OS, starting at day 29, stratified by response. Disclosures Alousi: Therakos, Inc: Research Funding.

Early Intervention with Mesenchymal Stromal Cells for Refractory Grade III-IV Graft Versus Host Disease In Children Results In Excellent Long Term Outcome

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 2336-2336
Author(s):  
Lynne Margaret Ball ◽  
Maria E. Bernardo ◽  
Jaap Jan Zwaginga ◽  
Maarten van Tol ◽  
Angela Cometa ◽  
...  
Keyword(s):  
Overall Survival ◽  
Graft Versus Host Disease ◽  
Immune Suppression ◽  
Term Survival ◽  
Long Term Survival ◽  
Host Disease ◽  
Graft Versus Host ◽  
Steroid Refractory

Abstract Abstract 2336 Mesenchymal stromal cell (MSC) infusions have been reported to be effective in patients with severe, steroid-refractory, acute graft-versus-host disease (aGVHD). However, long term comprehensive follow up data on pediatric patients is limited. We analyzed the outcome of 37 children receiving MSC for steroid-refractory aGvHD in two centers between January 2005 and December 2009 (characteristics see Table 1). A median of 2 infusions (range 1–13) were administered, with a median cell dose of 2×106/kg (range 0.9–3.0). MSC were from 3rd party HLA-mismatched donors (n=31), haploidentical relative (n=3) or both (n=3). (see Table 2) Fifteen children had either no (n=6) or partial (n=9) response to MSC. In this group, transplantation-related mortality (TRM) was 60%. Complete response (CR) was observed in 22 children, TRM being 14%. (p=0.005). Among the 28 patients with hematological malignancies, 5 relapsed, three with CR and two with PR. With a median follow-up of 2.3 years (range 7 months–4.7 years), overall survival was 62% with 87% versus 27% in patients who did or did not achieve CR after MSC respectively (p value <0.001). MSC after 2009 given at the time of steroid failure (median 8 days range 4 to 24) compared to pre 2009 (median 24 days range 5 to 85) (Maan-Whitney U = 65.5 two tailed p= 0.002) reduced fatal infections and was associated with a trend to better overall survival at 2 years post MSC infusion (p = 0.07). Although infections were evident at the time of immune suppression and mortality was high in NR/PR, response to MSC allows for reduction and eventual discontinuation of pharmacological immune suppression. Long term survival in responders is associated with eventual immune recovery, no late infections and persistent remission status. Treatment of steroid refractory aGVHD should aim to induce rapid stable control and early reduction of steroids to reduce TRM from viral reactivations. We conclude that MSC are ideal candidates for this purpose. Our results show that children responding to MSC treatment for severe steroid refractory GvHD have an excellent long term survival. Legend: ALL = acute lymphoblastic leukemia; AML = acute myeloid leukemia; MDS = myelodysplastic syndrome; jMML = juvenile myelomonocytic leukemia; HLH = hemophagocytic lymphohistiocytosis; MSD = matched sibling donor; (m) MUD (mis) Matched unrelated donor; PBSC = peripheral blood stem cells; TBI = total body irradiation; CSA = Cyclosporine A; MTX = short course methrotrexate; ATG = anti-thymocyte globulin; HSCT = hematopoietic stem cell transplantation; DLI = donor lymphocyte infusion; GvHD = graft versus host disease; M=Male; F=Female. Disclosures: No relevant conflicts of interest to declare.

Response and Long-Term Outcome After Treatment With Third-Party Mesenchymal Stromal Cells - Updated Results In 58 Patients With Steroid-Refractory Acute Graft-Versus Host Disease -

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 4612-4612
Author(s):  
Felix von Dalowski ◽  
Michael Kramer ◽  
Martin Wermke ◽  
Christoph Röllig ◽  
Nael Alakel ◽  
...  
Keyword(s):  
Overall Survival ◽  
Partial Response ◽  
Stromal Cells ◽  
Acute Gvhd ◽  
Third Party ◽  
Graft Versus Host ◽  
Historic Cohort ◽  
Steroid Refractory ◽  
Acute Graft

Introduction Acute Graft-versus-Host Disease (aGvHD) remains the major cause of morbidity and mortality after allogeneic hematopoietic stem cell transplantation (HSCT). So far, corticosteroids are the only first-line treatment proven to be effective. Steroid-resistance is associated with poor outcome and no commonly accepted second-line salvage therapy is available until now. Mesenchymal stromal cells (MSC) have shown promising immunomodulatory effects and have been suggested as cell-based treatment option in patients with steroid-refractory acute GvHD. Here, we report our experience from a large cohort of patients treated with MSC. Patients, Materials and Methods Fifty-eight patients with steroid-refractory acute GvHD after HSCT were treated with MSC at our centre between 2007 and 2012. MSC were obtained from volunteer third-party donors and expanded in platelet-lysate containing medium. Median age at transplantation was 55 years (range 19-71). In 25 patients AML was diagnosed initially. Further diagnoses were CLL (n=9), ALL (n=5), MDS (n=5) and others (n=14). For transplantation, patients received peripheral blood stem cells (n=56) or bone marrow (n=2) from HLA-identical (n=43) or HLA mismatched donors (n=15) after varying reduced-intensity conditioning regimens (n=50) or myeloablative conditioning (n=8). Eight-teen patients received anti-thymocyte globulin as part of their conditioning. GvHD prophylaxis consisted mostly of cyclosporine A (CsA) plus methotrexate, CsA alone or CsA plus mycophenolate mofetile. The majority of patients suffered from aGvHD grade IV (79%), median interval from HSCT to onset of GvHD was 36 days. Involvement of gastrointestinal tract, liver and skin was observed in 91%, 43% and 41% of patients, respectively. Most patients (64%) had involvement of 2 or 3 organs at the same time. Besides corticosteroids, 48 patients (83%) received at least one additional immunosuppressive agent before the first MSC infusion. Response was assessed 28 days after initiation of MSC treatment and overall survival of the MSC treated cohort was compared to a historic patient cohort (n=36) with steroid-refractory aGvHD not receiving MSC. Results Median time between onset of aGvHD and first application of MSC was 12 days (range 6-62). Altogether 139 doses of MSC were transfused at a median dosage of 0.99x106cells/kg bodyweight (range 0.448 -2.077). A median number of 2 MSC infusions were given per patient (range 1-6). During MSC treatment, 39 patients needed further escalation of immunosuppression due to persistence or progression of GvHD. No side-effects directly related to MSC infusions were observed. Four weeks after first MSC application, 9% (n=5) of patients showed a complete response (CR), 9% (n=5) exhibited a very good partial response (VGPR), 29% (n=17) experienced partial response (PR) whereas 53% (n=31) were classified as non-responders. There were no significant differences in organ specific response. One-year and 2-year-survival after onset of aGvHD was 19% [95% CI: 9-29%] and 17% [95% CI: 7-26%], respectively. Median survival was 69 days [95% CI: 38-100 days]. Causes of death were aGvHD (54%), infectious complications (29%), relapse of the underlying disease (4%) and others (13%). Median follow up was 1689 days and at the end of follow-up, 8 patients were still alive (median survival after HSCT 58 months). Of those eight, 6 were initially classified as responders (CR n=4, VGPR n=1, PR n=1). Responders showed higher survival compared to non-responders (hazard ratio 0.38; p=0.004). Overall survival in the MSC treated cohort did not differ significantly to that of the historic cohort not receiving MSC. Conclusions MSC in combination with further immunosuppressive strategies resulted in a response rate of 47% in patients with steroid-refractory aGvHD and should therefore be considered as a valuable treatment option in a difficult clinical situation. However, compared to our historic cohort, treatment with MSC did not lead to an improvement of survival. Future studies need to define which patient subsets are likely to benefit from MSC therapy and whether certain MSC preparations from specific donors may have a more pronounced and long-lasting immunosuppressive effect. Therefore, further insights into MSC biology are urgently needed to optimize the translation into clinical practice. Disclosures: No relevant conflicts of interest to declare.

A Randomized Study of Cyclosporine and Methotrexate with or without Methylprednisolone for the Prevention of Graft-Versus-Host Disease: Improved Long-Term Survival with the Triple Prophylaxis

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 2241-2241
Author(s):  
Tapani Ruutu ◽  
Anne Nihtinen ◽  
Riitta Niittyvuopio ◽  
Eeva Juvonen ◽  
Liisa Volin
Keyword(s):  
Graft Versus Host Disease ◽  
Cumulative Incidence ◽  
Acute Gvhd ◽  
Not Given ◽  
Term Survival ◽  
Graft Versus Host ◽  
Gvhd Prophylaxis ◽  
To Receive

Abstract Background: In a previously published single-center study (Blood 2000) we randomized 108 consecutive adult patients with a malignant hematological disorder undergoing allogeneic bone marrow transplantation from an HLA-identical sibling donor to receive (n=53) or not to receive (n=55) methylprednisolone (MP+ or MP-, respectively) as a part of graft-versus-host disease (GVHD) prophylaxis. All patients received cyclosporine A and methotrexate. MP administration was initiated on day 14 post-transplantation with 0.5 mg/kg, the dose was increased to 1 mg/kg on day 21 and thereafter tapered and discontinued on day 110. The cumulative incidence of acute GVHD was 19 % among the patients given and 56 % among those not given MP prophylaxis (p=0.0001), and that of grade II-IV acute GVHD 13 and 36 %, respectively (p=0.005). There was a non-significant trend toward a lower cumulative incidence of chronic GVHD (cGVHD) and better survival in the MP+ group. There were fewer infections and the stay at hospital was shorter among the patients given MP prophylaxis. No difference was seen in the relapse rate. We have now carried out a long-term follow-up to find out possible late effects of the intensified GVHD prophylaxis. Results: The median follow-up time of living patients was 24.5 (range 22.7-26.9) years; two patients were lost for follow-up at 37 and 80 months. In the MP+ group the overall survival (OS, p=0.021) (Figure 1) and relapse-free survival (RFS, p=0.024) were significantly higher and the non-relapse mortality (NRM) lower (p=0.003) than in the MP- group. There was a trend toward lower cumulative incidence of cGVHD in the MP+ group (36 vs. 48 %, p=0.17). The prevalence of cGVHD, analyzed with data available from ten years of scheduled follow-up, was significantly (p=0.031) lower in the MP+ group and the difference became more marked with time. Among the patients alive at ten years, none in the MP+ group but 28 % of the patients in the MP- group had active cGVHD. There was no difference in the relapse rate between the MP+ and MP- groups, the cumulative incidences were 36 and 38 %, respectively. Seven patients in each group developed a secondary malignancy, one patient in both groups had two secondary tumors. At 15 years, the survival was 55 % in the MP+ group and 47 % in the MP- group, and the NRM 21 and 30 %, respectively. Thereafter there was marked non-relapse mortality in the MP- group, eleven patients died after this time point, whereas there were no deaths during this period in the MP+ arm. At the end of the follow-up, the OS in the MP+ and MP- groups were 55 and 20 % and the RFS 54 and 18 %, respectively. The causes of the late deaths in the MP- group were: bacterial infection 3, obstructive bronchiolitis 1, acute myocardial infarction 1, intracerebral bleeding 1, sudden death of unknown cause 1, lung cancer 2, colon cancer 1, and esophagus cancer 1. Conclusion: The addition of corticosteroid to cyclosporine and methotrexate in GVHD prophylaxis, resulting in a marked decrease in the incidence of acute GVHD, did not cause adverse late effects. Long-term survival was higher among the patients given MP prophylaxis. Unexpectedly, there was marked late non-relapse mortality in the group not given MP prophylaxis, possibly contributed to by the higher prevalence of cGVHD. Disclosures No relevant conflicts of interest to declare.

scholarly journals Long-Term Follow-Up of a Pilot Study Using Placenta-Derived Decidua Stromal Cells for Severe Acute Graft-versus-Host Disease

2019 ◽  
Vol 25 (10) ◽  
pp. 1965-1969 ◽  
Author(s):  
Behnam Sadeghi ◽  
Mats Remberger ◽  
Britt Gustafsson ◽  
Jacek Winiarski ◽  
Gianluca Moretti ◽  
...  
Keyword(s):  
Pilot Study ◽  
Graft Versus Host Disease ◽  
Stromal Cells ◽  
Host Disease ◽  
Graft Versus Host ◽  
Long Term Follow Up ◽  
Acute Graft

Excellent Long-Term Survival of Patients with Steroid-Refractory and Steroid-Dependent Acute Graft-Versus-Host Disease after Extracorporeal Photochemotherapy.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 1244-1244
Author(s):  
Hildegard T. Greinix ◽  
Robert M. Knobler ◽  
Nina Worel ◽  
Margit Mitterbauer ◽  
Axel Schulenburg ◽  
...  
Keyword(s):  
Graft Versus Host Disease ◽  
Acute Gvhd ◽  
Complete Response ◽  
Graft Versus Host ◽  
Steroid Dependent ◽  
Grade Ii ◽  
Grade Iii ◽  
Steroid Refractory ◽  
Acute Graft

Abstract Despite posttransplantation immunosuppressive therapy, acute graft-versus-host disease (GVHD) remains a major cause of sickness and death. Second-line therapies for steroid-refractory acute GVHD have been used with limited success. Extracorporeal exposure of peripheral blood mononuclear cells to the photosensitizing agent 8-methoxypsoralen and UV-A radiation (ECP) has been shown to be effective in the treatment of selected diseases mediated by T cells. We have reviewed the responses and long-term outcome of 59 hematopoietic stem cell transplant (HSCT) patients treated from 1996 to 2003 with ECP for steroid-refractory acute GVHD, defined as progression or no improvement of acute GVHD after a minimum of 4 (range, 4–49, median 17) days of treatment with prednisone (n=37) or steroid-dependent acute GVHD, defined as flare-up of GVHD during prednisone taper (n=22). Patients received HSCT from 17 related and 42 unrelated donors. In 28 cases an HLA-mismatch between recipient and donor was present. Prior to ECP, grade III–IV GVHD was observed in 23 patients (39%) and grade II GVHD in 36 (61%). Organs involved included skin in 97% of patients, liver in 39%, and GI tract in 17%. Treatment consisted of ECP on two consecutive days per week (=1 cycle) for a median of 7 (range, 1–45) cycles administered within a median of 3 (range, 0.5–31) months in addition to cyclosporine A and prednisone. Three months after initiation of ECP complete resolution of GVHD was achieved in 82% of patients with cutaneous, 61% with liver, and 61% with gut involvement. Complete responses were obtained in 86% of patients with grade II, 55% of patients with grade III, and 30% of patients with grade IV acute GVHD. Probability of transplant-related mortality (TRM) at 4 years after HSCT is 15% in patients with complete response to ECP compared to 88% in patients not responding completely. After a median follow-up of 46 (range, 9–45) months since discontinuation of ECP, 28 (47%) patients are alive including 22 without chronic GVHD. Probability of survival (OS) at 4 years after HSCT is 59% in patients with complete response to ECP compared to 11% in patients not responding completely. Besides response to ECP only organ involvement and grade of GVHD at start of ECP, and ability to timely taper steroids during ECP had a significant impact on both TRM and OS. Thus, ECP is an effective adjunct therapy for acute steroid-refractory and steroid-dependent GVHD. Our long-term results demonstrate durability of responses without adverse events.

A Multicenter Retrospective Analysis on Pentostatin As Salvage Therapy of Severe Steroid Refractory Intestinal Acute Graft Versus Host Disease

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 3048-3048
Author(s):  
Stefan A. Klein ◽  
Thomas Schmitt ◽  
Gesine Bug ◽  
Johannes Schetelig ◽  
Rainer Schwerdtfeger ◽  
...  
Keyword(s):  
Salvage Therapy ◽  
Gi Tract ◽  
First Line ◽  
Term Survival ◽  
Long Term Survival ◽  
Graft Versus Host ◽  
Probability Of Survival ◽  
Steroid Refractory ◽  
Acute Graft

Abstract Abstract 3048 Acute graft-versus-host disease (aGvHD) of the gastrointestinal (GI) tract is still a major clinical challenge after allogeneic stem cell transplantation. Patients with steroid-refractory disease have a poor prognosis. Pentostatin, an inhibitor of adenosine deaminase, has shown efficacy as salvage therapy in steroid-refractory aGvHD of the GI tract in small single center studies. Here we report on the experience with pentostatin in severe steroid-refractory aGvHD of the GI tract at seven German transplant centers. PATIENTS: A total number of 123 patients who had been treated with pentostatin due to intestinal steroid-refractory aGvHD between 2000 and 2011 were retrospectively analyzed. Steroid-refractory aGvHD was defined as progression or no improvement of diarrhea despite treatment with prednisolone (≥ 2mg/kg/d) for ≥ 3 days. Pentostatin was infused at a dose of 1mg/m2 for 3 consecutive days. In patients with impaired renal function the dose of pentostatin was reduced. Patients received 1–4 cycles. Steroids and calcineurin inhibitors (CNI) were continued. Response after therapy with pentostatin was classified as complete (CR, no ongoing symptoms of GvHD), very good partial (VGPR, residual symptoms only) or no response (NR). 50 females and 73 males with a median age of 50 (range: 19–70) years were included. The underlying diseases were AML (n=71), ALL (n=15), CML/MPS (n=6), lymphoma (n=12), MDS (n=10), and multiple myeloma (n=9). 85 patients received reduced intensity and 38 myeloablative conditioning. Patients had been transplanted from matched related (n=38), matched unrelated (n=53) or mismatched donors (n=32). All patients suffered from severe steroid-refractory intestinal aGvHD overall grade III (n=59) or IV (n=64). Patients received pentostatin as first line salvage (n=109) or beyond first line salvage therapy (n=14). Results: 52 patients (43%) responded after salvage therapy with pentostatin. 39 patients (32%) achieved CR, 13 patients (11%) VGPR. Median survival was 104 days; 2-year and long term survival rates were 26 and 19% with a median follow up of 45 months. Among 109 patients who received pentostatin as first line salvage therapy 49 (45%) responded (37 × CR [34%] and 12 × VGPR [11%]). Median survival, 2-year and long term survival were essentially the same as in the total cohort of patients. After the first infusion of pentostatin clinical improvement occurred within a median of 14 (range: 1–58) days. 71 patients (57%) did not respond. Responding patients had a significantly (p<0.0001) higher probability of survival in comparison with non-responders (2 year survival 44 vs. 14%, long term survival 41 vs. 0%). 94 patients (76%) died (66% therapy related, 10% due to relapse of the malignant disease). Patients who had been transplanted from a matched related donor had a significantly (p=0.04) higher probability of survival in comparison with patients with other donors (2-year survival: 38 vs. 21%, long term survival 35 vs. 8%). 53% (n=20) of these patients responded. Out of the 109 patients who were treated with pentostatin as first line salvage therapy 15 received simultaneously additional immunsuppressive salvage therapies (infliximab, mesenchymal stem cells [MSC] or extracorporeal photopheresis [ECP]). None of these patients survived. 46 patients without CR after one cycle of pentostatin received further immunosuppressive salvage treatment: 28 of these patients were treated with 1–3 further cycles of pentostatin. 18 of the 46 patients received pentostatin plus simultaneous or subsequent additional immunsuppressive therapies (infliximab, alemtuzumab, basiliximab, MSC or ECP). In both groups the probability of survival was identical (2-year survival: 17%). Conclusions: The outcome after salvage therapy of III/IV° steroid-refractory intestinal aGvHD with pentostatin is at least within the range as reported for other salvage approaches. In this critical clinical situation pentostatin has some superior characteristics: a sustainable effect, moderate toxicity, easy application and cost-effectiveness. Moreover, this analysis suggests that the outcome of steroid-refractory aGvHD cannot be improved by the application of more than one immunosuppressive salvage drug in addition to steroids and CNI or by second line salvage approaches. Disclosures: Klein: Hospira: Honoraria, Research Funding. Off Label Use: pentostatin is not licensed for use in acute GvHD.

scholarly journals Long Term Follow-up of a Pilot Study Using Placenta-Derived Decidua Stromal Cells for Severe Acute Graft-Versus-Host Disease

2019 ◽  
Vol 25 (3) ◽  
pp. S247
Author(s):  
Olle Ringden ◽  
Mats Remberger ◽  
Britt Gustafsson ◽  
Jacek Winiarski ◽  
Bita Khoein ◽  
...  
Keyword(s):  
Pilot Study ◽  
Graft Versus Host Disease ◽  
Stromal Cells ◽  
Host Disease ◽  
Graft Versus Host ◽  
Long Term Follow Up ◽  
Acute Graft
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