Graft-Versus-Host Disease Prevention: Corticosteroids Revisited
Menés sur 228 patients ayant reçu une greffe de moelle osseuse haplo-identique (provenant d'un des parents), cet essai évalue l'intérêt d'un traitement prophylactique, comportant une faible dose de corticostéroïdes et délivré en fonction du rapport lymphocytes CD4/lymphocytes CD8 dans les greffons allogéniques, pour réduire le risque à 100 jours de maladie aiguë du greffon contre l'hôte
The morbidity caused by graft-versus-host disease (GVHD) limits the success of allogeneic stem-cell transplantation. For the past two decades, the regimen that was pioneered by the Seattle group that combined a calcineurin inhibitor with methotrexate has been the most widely adopted for the prevention of GVHD. Over the years, numerous trials have been performed to explore alternative regimens in an attempt to improve GVHD control and reduce toxicity related to the agents used to prevent GVHD. Several randomized trials have addressed the addition of corticosteroids to the standard regimen or whether to replace methotrexate with corticosteroids. However, the results of these trials have been mixed, and the addition of corticosteroids has not been routinely adopted in GVHD prevention regimens. In the article that accompanies this editorial, Chang et al demonstrate a reduction in the incidence of acute and chronic GVHD with the addition of corticosteroids to their GVHD prevention regimen in patients undergoing haploidentical transplantation. This trial provides an opportunity to consider both the opportunities and challenges of this type of trial design to identify new regimens to prevent GVHD and the applicability of these results to other transplantation settings...
Journal of Clinical Oncology , éditorial en libre accès, 2016