Decreasing the Steroid Rapidly May Help to Improve the Clinical Outcomes of Patients with Intestinal Steroid-refractory Acute Graft-versus-host Disease Receiving Basiliximab Treatment

Overview

Journal Front Oncol

Specialty Oncology

Date 2024 Apr 10

PMID 38595816

Authors

Cong Cheng

Dao-Xing Deng

Xiao-Hui Zhang

Lan-Ping Xu

Yu Wang

Chen-Hua Yan

Huan Chen

Yu-Hong Chen

Wei Han

Feng-Rong Wang

Jing-Zhi Wang

Yu-Qian Sun

Xiao-Jun Huang

Xiao-Dong Mo

Affiliations

Soon will be listed here.

Abstract

Intestinal steroid refractory acute graft-versus-host disease (SR-aGVHD) is the major cause of mortality in allogeneic hematopoietic stem cell transplantation (allo-HSCT). This retrospective cohort study aimed to identify the relationship between different steroid decreasing velocity and therapeutic response in patients with intestinal SR-aGVHD receiving basiliximab treatment, and also aimed to propose a reasonable steroid decreasing regimen for these patients. The median time for steroid dose decreasing to the 50% of initial dose and decreasing to the low-dose steroid for patients achieving ORR was 5 days and 12 days, respectively, which was both shorter than patients without achieving ORR. The ORR, NRM and survival in rapid and medium steroid decreasing group were all better than slow group. The cumulative incidence of ORR at any time was 90.4%, 78.1% and 62.3%, respectively, in rapid, medium, and slow group. The cumulative incidence of NRM at 1 year after basiliximab treatment was 18.7% (95% CI 11.3%-26.1%), 22.8% (95% CI 14.2%-31.4%) and 32.8% (95% CI 24.1%-41.5%), respectively, in rapid, medium, and slow group. The probability of OS at 1 year after basiliximab treatment was 76.9% (95% CI 68.9%-84.9%), 72.7% (95% CI 63.7%-81.7%), and 62.3% (95% CI 53.5%-71.1%), respectively, in rapid, medium, and slow group. Hence, it was helpful to decrease steroid to the 50% of initial dose ≤ 5 days and to the low-dose steroid ≤ 12 days after basiliximab treatment for intestinal SR-aGVHD patients, which may also be the reasonable steroid decrease protocol for these patients.

References

Xu L, Chen H, Chen J, Han M, Huang H, Lai Y . The consensus on indications, conditioning regimen, and donor selection of allogeneic hematopoietic cell transplantation for hematological diseases in China-recommendations from the Chinese Society of Hematology. J Hematol Oncol. 2018; 11(1):33. PMC: 5833104. DOI: 10.1186/s13045-018-0564-x. View

Schoemans H, Lee S, Ferrara J, Wolff D, Levine J, Schultz K . EBMT-NIH-CIBMTR Task Force position statement on standardized terminology & guidance for graft-versus-host disease assessment. Bone Marrow Transplant. 2018; 53(11):1401-1415. PMC: 6786777. DOI: 10.1038/s41409-018-0204-7. View

Gianotti L, Alexander J, Fukushima R, Pyles T . Steroid therapy can modulate gut barrier function, host defense, and survival in thermally injured mice. J Surg Res. 1996; 62(1):53-8. DOI: 10.1006/jsre.1996.0172. View

Zhang X, Chen J, Han M, Huang H, Jiang E, Jiang M . The consensus from The Chinese Society of Hematology on indications, conditioning regimens and donor selection for allogeneic hematopoietic stem cell transplantation: 2021 update. J Hematol Oncol. 2021; 14(1):145. PMC: 8441240. DOI: 10.1186/s13045-021-01159-2. View

Schoepe S, Schacke H, May E, Asadullah K . Glucocorticoid therapy-induced skin atrophy. Exp Dermatol. 2006; 15(6):406-20. DOI: 10.1111/j.0906-6705.2006.00435.x. View

Castilla-Llorente C, Martin P, McDonald G, Storer B, Appelbaum F, Deeg H . Prognostic factors and outcomes of severe gastrointestinal GVHD after allogeneic hematopoietic cell transplantation. Bone Marrow Transplant. 2014; 49(7):966-71. PMC: 4079749. DOI: 10.1038/bmt.2014.69. View

Wang A, Armstrong E, Armstrong A . Corticosteroids and wound healing: clinical considerations in the perioperative period. Am J Surg. 2013; 206(3):410-7. DOI: 10.1016/j.amjsurg.2012.11.018. View

MacMillan M, Weisdorf D, Wagner J, DeFor T, Burns L, Ramsay N . Response of 443 patients to steroids as primary therapy for acute graft-versus-host disease: comparison of grading systems. Biol Blood Marrow Transplant. 2002; 8(7):387-94. DOI: 10.1053/bbmt.2002.v8.pm12171485. View

Khandelwal P, Emoto C, Fukuda T, Vinks A, Neumeier L, Dandoy C . A Prospective Study of Alemtuzumab as a Second-Line Agent for Steroid-Refractory Acute Graft-versus-Host Disease in Pediatric and Young Adult Allogeneic Hematopoietic Stem Cell Transplantation. Biol Blood Marrow Transplant. 2016; 22(12):2220-2225. PMC: 5683393. DOI: 10.1016/j.bbmt.2016.09.016. View

10.

Schepper J, Collins F, Rios-Arce N, Kang H, Schaefer L, Gardinier J . Involvement of the Gut Microbiota and Barrier Function in Glucocorticoid-Induced Osteoporosis. J Bone Miner Res. 2019; 35(4):801-820. DOI: 10.1002/jbmr.3947. View

11.

Cai Z, Fan S, Sun X, Mo X, Yang G . Novel microfluidic device for measurable residual disease detection in acute leukemia. Innovation (Camb). 2023; 4(3):100408. PMC: 10060743. DOI: 10.1016/j.xinn.2023.100408. View

12.

Takahashi S, Hashimoto D, Hayase E, Ogasawara R, Ohigashi H, Ara T . Ruxolitinib protects skin stem cells and maintains skin homeostasis in murine graft-versus-host disease. Blood. 2018; 131(18):2074-2085. DOI: 10.1182/blood-2017-06-792614. View

13.

MacMillan M, Robin M, Harris A, DeFor T, Martin P, Alousi A . A refined risk score for acute graft-versus-host disease that predicts response to initial therapy, survival, and transplant-related mortality. Biol Blood Marrow Transplant. 2015; 21(4):761-7. PMC: 4359643. DOI: 10.1016/j.bbmt.2015.01.001. View

14.

Martin P, McDonald G, Sanders J, Anasetti C, Appelbaum F, Deeg H . Increasingly frequent diagnosis of acute gastrointestinal graft-versus-host disease after allogeneic hematopoietic cell transplantation. Biol Blood Marrow Transplant. 2004; 10(5):320-7. DOI: 10.1016/j.bbmt.2003.12.304. View

15.

Gratwohl A, Brand R, Frassoni F, Rocha V, Niederwieser D, Reusser P . Cause of death after allogeneic haematopoietic stem cell transplantation (HSCT) in early leukaemias: an EBMT analysis of lethal infectious complications and changes over calendar time. Bone Marrow Transplant. 2005; 36(9):757-69. DOI: 10.1038/sj.bmt.1705140. View

16.

Zeiser R, Blazar B . Acute Graft-versus-Host Disease - Biologic Process, Prevention, and Therapy. N Engl J Med. 2017; 377(22):2167-2179. PMC: 6034180. DOI: 10.1056/NEJMra1609337. View

17.

Garnett C, Apperley J, Pavlu J . Treatment and management of graft-versus-host disease: improving response and survival. Ther Adv Hematol. 2013; 4(6):366-78. PMC: 3854558. DOI: 10.1177/2040620713489842. View

18.

Matsumura-Kimoto Y, Inamoto Y, Tajima K, Kawajiri A, Tanaka T, Hirakawa T . Association of Cumulative Steroid Dose with Risk of Infection after Treatment for Severe Acute Graft-versus-Host Disease. Biol Blood Marrow Transplant. 2016; 22(6):1102-1107. DOI: 10.1016/j.bbmt.2016.02.020. View

19.

SPITZ J, Ghandi S, Taveras M, Aoys E, Alverdy J . Characteristics of the intestinal epithelial barrier during dietary manipulation and glucocorticoid stress. Crit Care Med. 1996; 24(4):635-41. DOI: 10.1097/00003246-199604000-00015. View

20.

Rashidi A, Dipersio J, Sandmaier B, Colditz G, Weisdorf D . Steroids Versus Steroids Plus Additional Agent in Frontline Treatment of Acute Graft-versus-Host Disease: A Systematic Review and Meta-Analysis of Randomized Trials. Biol Blood Marrow Transplant. 2016; 22(6):1133-1137. PMC: 5045896. DOI: 10.1016/j.bbmt.2016.02.021. View