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Pediatric acute graft‐versus‐host disease prophylaxis and treatment: surveyed real‐life approach reveals dissimilarities compared to published recommendations

Pediatric allogeneic hematopoietic cell transplantation (HCT) practices differ from those of adults, particularly the heterogeneity of transplantable nonmalignant diseases and the lower incidence of graft‐versus‐host disease (GVHD). Several guidelines regarding the management of acute (a) GVHD in ad...

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Autores principales: Lawitschka, Anita, Lucchini, Giovanna, Strahm, Brigitte, Dalle, Jean‐Hugues, Balduzzi, Adriana, Gibson, Brenda, Diaz De Heredia, Cristina, Wachowiak, Jacek, Dalissier, Arnaud, Vettenranta, Kim, Yaniv, Isaac, Bordon, Victoria, Bauer, Dorothea, Bader, Peter, Meisel, Roland, Peters, Christina, Corbacioglu, Selim
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7384018/
https://www.ncbi.nlm.nih.gov/pubmed/32133691
http://dx.doi.org/10.1111/tri.13601
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author Lawitschka, Anita
Lucchini, Giovanna
Strahm, Brigitte
Dalle, Jean‐Hugues
Balduzzi, Adriana
Gibson, Brenda
Diaz De Heredia, Cristina
Wachowiak, Jacek
Dalissier, Arnaud
Vettenranta, Kim
Yaniv, Isaac
Bordon, Victoria
Bauer, Dorothea
Bader, Peter
Meisel, Roland
Peters, Christina
Corbacioglu, Selim
author_facet Lawitschka, Anita
Lucchini, Giovanna
Strahm, Brigitte
Dalle, Jean‐Hugues
Balduzzi, Adriana
Gibson, Brenda
Diaz De Heredia, Cristina
Wachowiak, Jacek
Dalissier, Arnaud
Vettenranta, Kim
Yaniv, Isaac
Bordon, Victoria
Bauer, Dorothea
Bader, Peter
Meisel, Roland
Peters, Christina
Corbacioglu, Selim
author_sort Lawitschka, Anita
collection PubMed
description Pediatric allogeneic hematopoietic cell transplantation (HCT) practices differ from those of adults, particularly the heterogeneity of transplantable nonmalignant diseases and the lower incidence of graft‐versus‐host disease (GVHD). Several guidelines regarding the management of acute (a) GVHD in adult HCT have been published. We aimed to capture the real‐life approaches for pediatric aGVHD prophylaxis/treatment, and data from 75/193 (response rate 39%) EBMT centers (26 countries) were included, representing half (48%) of the pediatric EBMT‐HCT activity. Results with ≥75% approval from respondents (74/75) for GVHD prophylaxis after myeloablative HCT for malignancies partially contradict published guidelines: Single‐agent cyclosporine A (CsA) was used for matched sibling donor HCT in 47%; blood CsA levels were reported lower; the relapse risk in malignant diseases influenced GVHD prophylaxis with early withdrawal of CsA; distinct longer duration of CsA was employed in nonmalignant diseases. Most centers used additional anti‐thymocyte globulin for matched unrelated and mismatched donor HCT, but not for matched siblings. Regarding prophylaxis in nonmyeloablative conditioning (mainly for nonmalignant diseases), responses showed broad heterogeneity. High conformity was found for first‐line treatment; however, results regarding steroid‐refractory aGVHD indicate an earlier diagnosis in children. Our findings highlight the need for standardized pediatric approaches toward aGVHD prophylaxis/treatment differentiated for malignant and nonmalignant underlying diseases.
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spelling pubmed-73840182020-07-28 Pediatric acute graft‐versus‐host disease prophylaxis and treatment: surveyed real‐life approach reveals dissimilarities compared to published recommendations Lawitschka, Anita Lucchini, Giovanna Strahm, Brigitte Dalle, Jean‐Hugues Balduzzi, Adriana Gibson, Brenda Diaz De Heredia, Cristina Wachowiak, Jacek Dalissier, Arnaud Vettenranta, Kim Yaniv, Isaac Bordon, Victoria Bauer, Dorothea Bader, Peter Meisel, Roland Peters, Christina Corbacioglu, Selim Transpl Int Clinical Research Pediatric allogeneic hematopoietic cell transplantation (HCT) practices differ from those of adults, particularly the heterogeneity of transplantable nonmalignant diseases and the lower incidence of graft‐versus‐host disease (GVHD). Several guidelines regarding the management of acute (a) GVHD in adult HCT have been published. We aimed to capture the real‐life approaches for pediatric aGVHD prophylaxis/treatment, and data from 75/193 (response rate 39%) EBMT centers (26 countries) were included, representing half (48%) of the pediatric EBMT‐HCT activity. Results with ≥75% approval from respondents (74/75) for GVHD prophylaxis after myeloablative HCT for malignancies partially contradict published guidelines: Single‐agent cyclosporine A (CsA) was used for matched sibling donor HCT in 47%; blood CsA levels were reported lower; the relapse risk in malignant diseases influenced GVHD prophylaxis with early withdrawal of CsA; distinct longer duration of CsA was employed in nonmalignant diseases. Most centers used additional anti‐thymocyte globulin for matched unrelated and mismatched donor HCT, but not for matched siblings. Regarding prophylaxis in nonmyeloablative conditioning (mainly for nonmalignant diseases), responses showed broad heterogeneity. High conformity was found for first‐line treatment; however, results regarding steroid‐refractory aGVHD indicate an earlier diagnosis in children. Our findings highlight the need for standardized pediatric approaches toward aGVHD prophylaxis/treatment differentiated for malignant and nonmalignant underlying diseases. John Wiley and Sons Inc. 2020-04-02 2020-07 /pmc/articles/PMC7384018/ /pubmed/32133691 http://dx.doi.org/10.1111/tri.13601 Text en © 2020 The Authors. Transplant International published by John Wiley & Sons Ltd on behalf of Steunstichting ESOT This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.
spellingShingle Clinical Research
Lawitschka, Anita
Lucchini, Giovanna
Strahm, Brigitte
Dalle, Jean‐Hugues
Balduzzi, Adriana
Gibson, Brenda
Diaz De Heredia, Cristina
Wachowiak, Jacek
Dalissier, Arnaud
Vettenranta, Kim
Yaniv, Isaac
Bordon, Victoria
Bauer, Dorothea
Bader, Peter
Meisel, Roland
Peters, Christina
Corbacioglu, Selim
Pediatric acute graft‐versus‐host disease prophylaxis and treatment: surveyed real‐life approach reveals dissimilarities compared to published recommendations
title Pediatric acute graft‐versus‐host disease prophylaxis and treatment: surveyed real‐life approach reveals dissimilarities compared to published recommendations
title_full Pediatric acute graft‐versus‐host disease prophylaxis and treatment: surveyed real‐life approach reveals dissimilarities compared to published recommendations
title_fullStr Pediatric acute graft‐versus‐host disease prophylaxis and treatment: surveyed real‐life approach reveals dissimilarities compared to published recommendations
title_full_unstemmed Pediatric acute graft‐versus‐host disease prophylaxis and treatment: surveyed real‐life approach reveals dissimilarities compared to published recommendations
title_short Pediatric acute graft‐versus‐host disease prophylaxis and treatment: surveyed real‐life approach reveals dissimilarities compared to published recommendations
title_sort pediatric acute graft‐versus‐host disease prophylaxis and treatment: surveyed real‐life approach reveals dissimilarities compared to published recommendations
topic Clinical Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7384018/
https://www.ncbi.nlm.nih.gov/pubmed/32133691
http://dx.doi.org/10.1111/tri.13601
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