Clinical characterization and outcomes in chronic graft-versus-host disease ; Klinička karakterizacija i ishodi kronične bolesti presatka protiv domaćina

Allogeneic hematopoietic stem cells in peripheral blood transplantation (alloPBSCT) or bone marrow transplantation (alloBMT) have different biological characteristics which may affect differently prognostic factors for incidence and severity of chronic graft-versus-host disease (cGVHD). The first study included 87 patients who survived at least 100 days after matched related donor myeloablative transplantation. Factors significantly associated with higher incidence of cGVHD after alloPBSCT included CMV-positive donor, acute skin GVHD, and diagnoses other than lymphoma. The data suggest there some cGVHD prognostic factors are unique to recipients of alloPBSCT. The second study was based on the donor-derived T cells, by analyzing their impact of ex vivo on cGVHD was analyzed in a randomized multicenter trial involving unrelated donor marrow transplants. A total of 404 patients diagnosed with hematologic malignancies received a total body irradiation–based myeloablative conditioning regimen. Survival at 3 years from diagnosis of cGVHD was similar, in the same way as the proportion of patients with cGVHD who discontinued immunosuppression. Incidence of serious infections and leukemia relapse were similar on both treatment arms. In spite of a significant reduction of acute GVHD, TCD did not reduce the incidence of cGVHD or improve survival in patients who developed it. Lastly, the National Institutes of Health (NIH) Chronic Graft-versus-Host Disease (GVHD) Consensus Response Criteria Working Group recommended several measures to document serial evaluations of chronic GVHD organ involvement. Provisional definitions of complete response, partial response, and progression were proposed for each organ and for the overall outcome. Based on publications over the last 9 years, the 2014 Working Group has updated its recommendations for measures and interpretation of organ and overall responses. Major changes include eliminating several clinical parameters from the determination of response, updating or adding new organ ...