Predictors for Permanent Discontinuation of Systemic Immunosuppression in Severely Affected Chronic Graft-Versus-Host Disease Patients
Autor: | Tiffani Taylor, Jacqueline W. Mays, Nataliya P. Buxbaum, Steven Z. Pavletic, Kristin Baird, Sandra A. Mitchell, Daniel H. Fowler, Annie Im, Lauren M. Curtis, Seth M. Steinberg, Edward W. Cowen, Ronald E. Gress, Dominique C. Pichard, Daniele Avila, Filip Pirsl |
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Rok vydání: | 2017 |
Předmět: |
Adult
Male medicine.medical_specialty Adolescent medicine.medical_treatment Aftercare Graft vs Host Disease Disease Systemic therapy Article Young Adult 03 medical and health sciences 0302 clinical medicine Internal medicine Humans Medicine Cumulative incidence Prospective Studies Child Aged Immunosuppression Therapy Transplantation business.industry Incidence (epidemiology) Immunosuppression Hematology Middle Aged medicine.disease Confidence interval Surgery Discontinuation Graft-versus-host disease Child Preschool 030220 oncology & carcinogenesis Chronic Disease Female business Immunosuppressive Agents 030215 immunology |
Zdroj: | Biology of Blood and Marrow Transplantation. 23:1980-1988 |
ISSN: | 1083-8791 |
Popis: | Predicting the duration of systemic therapy in patients with chronic graft-versus-host disease (cGVHD) is of critical clinical importance when counseling patients and for treatment planning. cGVHD characteristics associated with this outcome have not been studied in severely affected patients. The National Institutes of Health (NIH) cGVHD scoring provides a standardized set of organ severity measures that could represent clinically useful and reproducible predictive characteristics. We analyzed 227 previously treated patients most with moderate (n = 54) or severe (n = 170) cGVHD defined by NIH criteria who were prospectively enrolled in a natural history protocol (NCT00092235). Patients received a median of 4 prior systemic therapy regimens and were seen at the NIH for a single time-point visit and were then monitored for survival and ability to discontinue cGVHD systemic therapy. With a median follow-up of 71.1 months, the cumulative incidence of systemic therapy discontinuation was 9.5% (95% confidence interval, 6.0% to 13.9%) at 2 years and 27.7% (95% confidence interval, 20.9% to 34.8%) by 5 years after the initial visit. Factors associated with a higher incidence of immunosuppression discontinuation included lower NIH global severity (P = .019) and lung (P = .030) scores and less extensive deep sclerosis (37% body surface area, P = .024). Lower patient- and clinician-reported 0 to 10 severity NIH scores and noncyclosporine prophylaxis regimens were also associated with higher incidence of immunosuppression discontinuation (P .05). In conclusion, we found low success rates for immune suppression discontinuation in previously treated patients who were severely affected with cGVHD. NIH scoring and clinical measures provide new standardized disease-specific tools to predict discontinuation of systemic therapy. |
Databáze: | OpenAIRE |
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