Chronic graft-versus-host disease : second line therapy review

Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2017 ; Graft-versus-Host disease (GVHD) is a complication of bone marrow transplant. It has two forms: acute and chronic. In this work we’ll only address the chronic one (cGVHD). cGVHD is a very frequent complication of the transplant (up to 50% of the patients) and a major one, given its high mortality rate, being the main cause of death in these patients, apart from the recurrence of the primary malignancy. Even thought our understanding of GVHD is far from complete, some progresses are being made. Firstly, the disease itself is being defined differently, being no longer just a temporal division between the acute GVHD (if occurred in the first 100 days after the transplant) and the chronic form (after the 100 day mark) but a more precise distinction based on the clinical manifestations, which are different between both forms. Even more, new criteria to evaluate the manifestations and the overall severity of the cGVHD have been developed, reflecting the advances in this area and enabling a better management of the patients. cGVHD treatment is very complex and far from perfect. Nowadays, the first approach relies on Corticosteroids plus a Calcineurin inhibitor. However, this treatment option has a limited efficacy (with 10% of the patients without any improvement and less than 50% only with a partial response). So, many of the patients will require second line therapy, however this isn´t perfect either. Even though there is a vast amount of options and in constant update, the number of studies is small and in many times the results aren´t satisfactory, making the clinical decision very hard and relying in a “trial and error” approach. So, with all this in mind, we develop this work in order to address every single one of these second line therapies and make some conclusions regarding them. ; A Doença de Enxerto-vs-Hospedeiro (DEVH) é uma complicação decorrente do transplante de medula óssea. A DEVH pode ser ...