Diagnosis and treatment of pulmonary chronic GVHD: Report from the consensus conference on clinical practice in chronic GVHD

G. C. Hildebrandt; T. Fazekas; A. Lawitschka; H. Bertz; H. Greinix; J. Halter; S. Z. Pavletic; E. Holler; D. Wolff

doi:10.1038/bmt.2011.35

Diagnosis and treatment of pulmonary chronic GVHD: Report from the consensus conference on clinical practice in chronic GVHD

G. C. Hildebrandt, T. Fazekas, A. Lawitschka, H. Bertz, H. Greinix, J. Halter, S. Z. Pavletic, E. Holler, D. Wolff

Research output: Contribution to journal › Review article › peer-review

151 Scopus citations

Abstract

This consensus statement established under the auspices of the German working group on BM and blood stem cell transplantation (DAG-KBT), the German Society of Hematology and Oncology (DGHO), the Austrian Stem Cell Transplant Working Group, the Swiss Blood Stem Cell Transplantation Group (SBST) and the German-Austrian Pediatric Working Group on SCT (Päd-Ag-KBT) summarizes current evidence for diagnosis, immunosuppressive and supportive therapy to provide practical guidelines for the care and treatment of patients with pulmonary manifestations of chronic GVHD (cGVHD). Pulmonary cGVHD can present with obstructive and/or restrictive changes. Disease severity ranges from subclinical pulmonary function test (PFT) impairment to respiratory insufficiency with bronchiolitis obliterans being the only pulmonary complication currently considered diagnostic of cGVHD. Early diagnosis may improve clinical outcome, and regular post-transplant follow-up PFTs are recommended. Diagnostic work-up includes high-resolution computed tomography, bronchoalveolar lavage and histology. Topical treatment is based on inhalative steroids plus beta-agonists. Early addition of azithromycin is suggested. Systemic first-line treatment consists of corticosteroids plus, if any, continuation of other immunosuppressive therapy. Second-line therapy and beyond includes extracorporeal photopheresis, mammalian target of rapamycin inhibitors, mycophenolate, etanercept, imatinib and TLI, but efficacy is limited. Clinical trials are urgently needed to improve understanding and treatment of this deleterious complication.

Original language	English
Pages (from-to)	1283-1295
Number of pages	13
Journal	Bone Marrow Transplantation
Volume	46
Issue number	10
DOIs	https://doi.org/10.1038/bmt.2011.35
State	Published - Oct 2011

Bibliographical note

Funding Information:
We thank all participating centers of conferences and surveys, which included participants from the transplant centers in Augsburg, Basel, Berlin, Cologne, Dresden, Duesseldorf, Erlan-gen, Essen, Freiburg, Greifswald, Hamburg, Hannover, Heidelberg, Jena, Kiel, Leipzig, Linz, Mainz, Münster, Munich, Nantes, Nuernberg, Oldenburg, Paris, Regensburg, Rostock, Tuebingen, Ulm, Vienna, Wiesbaden and Wuerzburg. We thank Anna Hackl for evaluating the survey on treatment of cGVHD. The conference was supported by the Jose Carreras Foundation project ‘Competence center GVHD Regensburg’. We convey our special thanks to Dr Nicolai Kittan for his critical review of the manuscript and figure design.

Keywords

allo-SCT
chronic GVHD
lung
obliterative bronchiolitis
treatment

ASJC Scopus subject areas

Hematology
Transplantation

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Cite this

@article{a822c87166c147cfb43ee54eb2a674ac,

title = "Diagnosis and treatment of pulmonary chronic GVHD: Report from the consensus conference on clinical practice in chronic GVHD",

abstract = "This consensus statement established under the auspices of the German working group on BM and blood stem cell transplantation (DAG-KBT), the German Society of Hematology and Oncology (DGHO), the Austrian Stem Cell Transplant Working Group, the Swiss Blood Stem Cell Transplantation Group (SBST) and the German-Austrian Pediatric Working Group on SCT (P{\"a}d-Ag-KBT) summarizes current evidence for diagnosis, immunosuppressive and supportive therapy to provide practical guidelines for the care and treatment of patients with pulmonary manifestations of chronic GVHD (cGVHD). Pulmonary cGVHD can present with obstructive and/or restrictive changes. Disease severity ranges from subclinical pulmonary function test (PFT) impairment to respiratory insufficiency with bronchiolitis obliterans being the only pulmonary complication currently considered diagnostic of cGVHD. Early diagnosis may improve clinical outcome, and regular post-transplant follow-up PFTs are recommended. Diagnostic work-up includes high-resolution computed tomography, bronchoalveolar lavage and histology. Topical treatment is based on inhalative steroids plus beta-agonists. Early addition of azithromycin is suggested. Systemic first-line treatment consists of corticosteroids plus, if any, continuation of other immunosuppressive therapy. Second-line therapy and beyond includes extracorporeal photopheresis, mammalian target of rapamycin inhibitors, mycophenolate, etanercept, imatinib and TLI, but efficacy is limited. Clinical trials are urgently needed to improve understanding and treatment of this deleterious complication.",

keywords = "allo-SCT, chronic GVHD, lung, obliterative bronchiolitis, treatment",

author = "Hildebrandt, {G. C.} and T. Fazekas and A. Lawitschka and H. Bertz and H. Greinix and J. Halter and Pavletic, {S. Z.} and E. Holler and D. Wolff",

note = "Funding Information: We thank all participating centers of conferences and surveys, which included participants from the transplant centers in Augsburg, Basel, Berlin, Cologne, Dresden, Duesseldorf, Erlan-gen, Essen, Freiburg, Greifswald, Hamburg, Hannover, Heidelberg, Jena, Kiel, Leipzig, Linz, Mainz, M{\"u}nster, Munich, Nantes, Nuernberg, Oldenburg, Paris, Regensburg, Rostock, Tuebingen, Ulm, Vienna, Wiesbaden and Wuerzburg. We thank Anna Hackl for evaluating the survey on treatment of cGVHD. The conference was supported by the Jose Carreras Foundation project {\textquoteleft}Competence center GVHD Regensburg{\textquoteright}. We convey our special thanks to Dr Nicolai Kittan for his critical review of the manuscript and figure design.",

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AU - Hildebrandt, G. C.

AU - Fazekas, T.

AU - Lawitschka, A.

AU - Bertz, H.

AU - Greinix, H.

AU - Halter, J.

AU - Pavletic, S. Z.

AU - Holler, E.

AU - Wolff, D.

N1 - Funding Information: We thank all participating centers of conferences and surveys, which included participants from the transplant centers in Augsburg, Basel, Berlin, Cologne, Dresden, Duesseldorf, Erlan-gen, Essen, Freiburg, Greifswald, Hamburg, Hannover, Heidelberg, Jena, Kiel, Leipzig, Linz, Mainz, Münster, Munich, Nantes, Nuernberg, Oldenburg, Paris, Regensburg, Rostock, Tuebingen, Ulm, Vienna, Wiesbaden and Wuerzburg. We thank Anna Hackl for evaluating the survey on treatment of cGVHD. The conference was supported by the Jose Carreras Foundation project ‘Competence center GVHD Regensburg’. We convey our special thanks to Dr Nicolai Kittan for his critical review of the manuscript and figure design.

PY - 2011/10

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N2 - This consensus statement established under the auspices of the German working group on BM and blood stem cell transplantation (DAG-KBT), the German Society of Hematology and Oncology (DGHO), the Austrian Stem Cell Transplant Working Group, the Swiss Blood Stem Cell Transplantation Group (SBST) and the German-Austrian Pediatric Working Group on SCT (Päd-Ag-KBT) summarizes current evidence for diagnosis, immunosuppressive and supportive therapy to provide practical guidelines for the care and treatment of patients with pulmonary manifestations of chronic GVHD (cGVHD). Pulmonary cGVHD can present with obstructive and/or restrictive changes. Disease severity ranges from subclinical pulmonary function test (PFT) impairment to respiratory insufficiency with bronchiolitis obliterans being the only pulmonary complication currently considered diagnostic of cGVHD. Early diagnosis may improve clinical outcome, and regular post-transplant follow-up PFTs are recommended. Diagnostic work-up includes high-resolution computed tomography, bronchoalveolar lavage and histology. Topical treatment is based on inhalative steroids plus beta-agonists. Early addition of azithromycin is suggested. Systemic first-line treatment consists of corticosteroids plus, if any, continuation of other immunosuppressive therapy. Second-line therapy and beyond includes extracorporeal photopheresis, mammalian target of rapamycin inhibitors, mycophenolate, etanercept, imatinib and TLI, but efficacy is limited. Clinical trials are urgently needed to improve understanding and treatment of this deleterious complication.

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Diagnosis and treatment of pulmonary chronic GVHD: Report from the consensus conference on clinical practice in chronic GVHD

Abstract

Bibliographical note

Keywords

ASJC Scopus subject areas

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