To assess current clinical practice in diagnosis and treatment of acute graft-versus-host disease (aGVHD), we performed a survey among German, Austrian, and Swiss allogeneic hematopoietic stem cell transplantation (allo-HSCT) centers. Thirty-four of 72 contacted centers (47%) completed both the diagnostic and therapeutic sections of the survey, representing 65% of allo-HSCT activity within the participating countries in 2011. Three pediatric centers answered as requested only the diagnostic part of the survey. In the presence of diarrhea and decreased oral intake after engraftment, only 4 centers (12%) do not perform any endoscopy before the start of immunosuppressive treatment. In case of a skin rash with the differential diagnosis of drug reaction, only 12 centers (35%) perform a skin biopsy up front, whereas 19 do so after failure of systemic steroids. In the presence of rapidly increasing cholestasis occurring without any other signs of aGVHD, 11 centers (32%) perform a liver biopsy up front and 14 only after failure of steroid treatment, whereas 9 centers do not perform a liver biopsy at all. Twenty centers (59%) use a percutaneous approach, 12 a transvenous approach, and 1 mini-laparoscopy for liver biopsies. First-line treatment of cutaneous aGVHD stage 1 consists of topical treatment alone in 17 of 31 responding centers (61%), whereas isolated cutaneous aGVHD stage III is treated with systemic steroids (prednisolone below 0.5 mg/kg/day n = 2, 0.5 to 1.0 mg/kg/day n = 10, above 1.0 to 2.5 mg/kg/day n = 19) without or with topical agents (steroids n = 10; calcineurin inhibitors n = 3). In gastrointestinal manifestations of aGVHD, 9 centers (29%) add topical to systemic steroids, and 3 consider topical steroids as the only treatment for mild gastrointestinal and cutaneous aGVHD. The choice of agent for second-line treatment as well as the sequence of administration are extremely heterogeneous, most likely due to a lack of convincing data published. Most frequently used are mycophenolate mofetil (n = 14) and extracorporeal photopheresis (n = 10). Our survey also demonstrates that clinicians chose salvage therapies for steroid-refractory aGVHD based on their centers' own clinical experience.
|Number of pages||10|
|Journal||Biology of Blood and Marrow Transplantation|
|State||Published - May 2013|
Bibliographical noteFunding Information:
Conflict of interest statement: D.W. received a research grant from Novartis and Therakos, a lecture fee from Fresenius, and serves as consultant for Falk-Pharma. H.B. received a lecture fee and travel support from Fresenius. S.K. received a research grant and honoraria from Hospira. H. G. received lecture fees from Therakos Inc. A.L., J.H., G.H., R.-G.M., M.S., S.M., M.E., and F.A. declare no conflict of interest.
Financial disclosure : The conference was supported by the Jose Carreras Foundation project “Competence center GvHD Regensburg.” H. G. was supported by European Commission Grant 037703 STEMDIAGNOSTICS.
- Acute graft-versus-host disease
- Allogeneic hematopoietic stem cell transplantation
- Immunosuppressive therapy
ASJC Scopus subject areas