| Autor: |
Kim DDH; Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON M5G 2M9, Canada., Popradi G; Health Centre, McGill University, Montreal, QC H4P 2P5, Canada., Lepic K; Juravinski Cancer Centre, McMaster University, Hamilton, ON L8V 5C2, Canada., Paulson K; CancerCare Manitoba, University of Manitoba, Winnipeg, Manitoba, MB R3E 0V9, Canada., Allan D; Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON K1H 8L6, Canada., Nampoothiri RV; Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON K1H 8L6, Canada., Lachance S; Hôpital Maisonneuve-Rosemont, Department of Medicine, University of Montreal, Montreal, QC H3C 3J7, Canada., Deotare U; London Health Sciences Centre, University of Western Ontario, London, ON N6A 5A5, Canada., White J; Vancouver General Hospital, British Columbia Cancer Agency, University of British Columbia, Vancouver, BC V5Z 1M9, Canada., Elemary M; Saskatchewan Cancer Agency, University of Saskatchewan, Saskatchewan, SK S7N 4H4, Canada., Jamani K; Tom Baker Cancer Centre, University of Calgary, Calgary, AB T2N 4N2, Canada., Fraga C; Queen Elizabeth II Health Sciences Centre, Dalhousie University, Halifax, NS B3H 4R2, Canada., Lemieux C; CHU de Québec-Université Laval, Université Laval, Québec, QC G1R 2J6, Canada., Novitzky-Basso I; Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON M5G 2M9, Canada., Law AD; Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON M5G 2M9, Canada., Kumar R; Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON M5G 2M9, Canada., Walker I; Juravinski Cancer Centre, McMaster University, Hamilton, ON L8V 5C2, Canada., Schultz KR; British Columbia Children's Hospital, University of British Columbia, Vancouver, BC V6H 3N1, Canada. |
| Abstrakt: |
This is a consensus-based Canadian guideline whose primary purpose is to standardize and facilitate the management of chronic graft-versus-host disease (cGvHD) across the country. Creating uniform healthcare guidance in Canada is a challenge for a number of reasons including the differences in healthcare authority structure, funding and access to healthcare resources between provinces and territories, as well as the geographic size. These differences can lead to variable and unequal access to effective therapies for GvHD. This document will provide comprehensive and practical guidance that can be applied across Canada by healthcare professionals caring for patients with cGvHD. Hopefully, this guideline, based on input from GvHD treaters across the country, will aid in standardizing cGvHD care and facilitate access to much-needed novel therapies. This consensus paper aims to discuss the optimal approach to the initial assessment of cGvHD, review the severity scoring and global grading system, discuss systemic and topical treatments, as well as supportive therapies, and propose a therapeutic algorithm for frontline and subsequent lines of cGvHD treatment in adults and pediatric patients. Finally, we will make suggestions about the future direction of cGvHD treatment development such as (1) a mode-of-action-based cGvHD drug selection, according to the pathogenesis of cGvHD, (2) a combination strategy with the introduction of newer targeted drugs, (3) a steroid-free regimen, particularly for front line therapy for cGvHD treatment, and (4) a pre-emptive approach which can prevent the progression of cGvHD in high-risk patients destined to develop severe and highly morbid forms of cGvHD. |
