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Allojeneik Hematopoietik Kök Hücre Transplantasyonu Sonrası Çocuklarda Steroide Dirençli Şiddetli Gastrointestinal Akut Graft-Versus-Host Hastalığının Tedavisi: Tek Merkez Deneyimi

Year 2024, Volume: 46 Issue: 3, 394 - 403, 27.05.2024
https://doi.org/10.20515/otd.1420314

Abstract

Akut graft-versus-host hastalığı, allojeneik hematopoietik kök hücre naklinin yaygın bir komplikasyonu olup önemli bir morbidite ve mortalite nedenidir. Sistemik steroid tedavisi, akut graft-versus-host hastalığı için ilk basamak tedavidir, ancak hastaların yaklaşık yarısı tedaviye direnç gösterebilmektedir. Akut graft-versus-host hastalığı için güvenli ve etkili tedavilerin keşfedilmesi, allojeneik kök hücre nakli yapılan hastaların sayısı arttıkça, özellikle durumu sistemik steroid tedavisine dirençli hale gelenler için daha önemli hale gelecektir. Yakın zamanda yayınlanmış çalışmalardan elde edilen verileri karşılaştırarak, steroide dirençli akut graft-versus-host hastalığı olan hastalar için mevcut alternatifleri gözden geçirerek tedavi seçeneklerini değerlendirmeyi amaçladık. 2010-2023 yılları arasında steroide bağımlı/refrakter akut graft-versus-host hastalığı olan 22 çocukta tedavinin güvenliğini ve etkinliğini retrospektif olarak inceledik. Akut graft-versus-host hastalığı olan 22 hastanın yedisi (%31,8) hayatta kaldı. Hayatta kalan hastaların takip gün sayısı ortalama 1141 (±403) idi. Evre III/IV akut graft-versus-host hastalığına sahip, tedaviye yanıt vermeyen 15 hasta farklı nedenlerden dolayı öldü. En sık ölüm nedeni enfeksiyondu (16 hastada 8 vaka, %53,3). Diğer ölüm nedenleri arasında mide-bağırsak kanaması (n=5, %33,3) ve kafa içi kanama (n=2, %13,3) yer aldı. Ayrıca morbiditeye neden olan faktörler değerlendirildiğinde üç hastada PRES sendromu, iki hastada hepatik veno-okluzif hastalık ve bir hastada hipertansiyon geliştiği görüldü. 1 yıl sonra tahmini hayatta kalma olasılığı %31,8 ve ortalama hayatta kalma süresi 655 gündü. Steroide dirençli akut graft-versus-host hastalığında kombinasyon tedavi yöntemlerinin etkisini retrospektif olarak değerlendirdik. Yeni tedavilerin güvenliğini ve etkinliğini kapsamlı, randomize klinik araştırmalarla göstermenin önemli olacağını düşünüyoruz

References

  • 1. Ferrara JL, Levine JE, Reddy P, Holler E. Graft-versus-host disease. Lancet. 2009;373:1550–61.
  • 2. Carpenter PA, Macmillan ML. Management of acute graft-versus-host disease in children. Pediatr Clin North Am. 2010;57:273–95.
  • 3. Harris AC, Young R, Devine S, Hogan WJ, Ayuk F, Bunworasate U, Chanswangphuwana C, Efebera YA, Holler E, Litzow M, Ordemann R, Qayed M, Renteria AS, Reshef R, Wölfl M, Chen YB, Goldstein S, Jagasia M, Locatelli F, Mielke S, Porter D, Schechter T, Shekhovtsova Z, Ferrara JL, Levine JE. International, multicenter standardization of acute graft-versus-host disease clinical data collection: a report from the Mount Sinai Acute GVHD International Consortium. Biol Blood Marrow Transplant. 2016;22:4–10.
  • 4. Jacobsohn DA. Acute graft‐versus‐host disease in children. Bone Marrow Transplant. 2008;41:215‐21.
  • 5. Faraci M, Caviglia I, Biral E, Morreale G, Giardino S, Garbarino L, Castagnola E, Dini G, Lanino E. Acute graft-versus-host disease in pediatric allogeneic hematopoietic stem cell transplantation. Single-center experience during 10 yr. Pediatr Transplant. 2012;16:887-93.
  • 6. Zeiser R, Blazar BR. Acute Graft-versus-Host Disease - Biologic Process, Prevention, and Therapy. N Engl J Med. 2017;377:2167-79.
  • 7. Winther-Jørgensen S, Nygaard M, Heilmann C, Ifversen M, Sørensen K, Müller K, Masmas T. Feasibility of extracorporeal photopheresis in pediatric patients with graft-versus-host disease after hematopoietic stem cell transplantation. Pediatr Transplant. 2019;23(4):e13416.
  • 8. Malard F, Huang XJ, Sim JPY. Treatment and unmet needs in steroid-refractory acute graft-versus-host disease. Leukemia. 2020;34:1229-40.
  • 9. MacMillan ML, Holtan SG, Rashidi A, DeFor TE, Blazar BR, Weisdorf DJ. Pediatric acute GVHD: clinical phenotype and response to upfront steroids. Bone Marrow Transplant. 2020;55(1):165–171.
  • 10. Penack O, Marchetti M, Ruutu T, Aljurf M, Bacigalupo A, Bonifazi F, Ciceri F, Cornelissen J, Malladi R, Duarte RF, Giebel S, Greinix H, Holler E, Lawitschka A, Mielke S, Mohty M, Arat M, Nagler A, Passweg J, Schoemans H, Socié G, Solano C, Vrhovac R, Zeiser R, Kröger N, Basak GW. Prophylaxis and management of graft versus host disease after stem-cell transplantation for haematological malignancies: updated consensus recommendations of the European Society for Blood and Marrow Transplantation. Lancet Haematol. 2020;7:e157-67.
  • 11. Przepiorka D, Weisdorf D, Martin P, Klingemann HG, Beatty P, Hows J, Thomas ED. 1994 Consensus Conference on Acute GVHD Grading. Bone Marrow Transplant. 1995;15:825-8.
  • 12. Schoemans HM, Lee SJ, Ferrara JL, Wolff D, Levine JE, Schultz KR, Shaw BE, Flowers ME, Ruutu T, Greinix H, Holler E, Basak G, Duarte RF, Pavletic SZ; EBMT (European Society for Blood and Marrow Transplantation) Transplant Complications Working Party and the “EBMT−NIH (National Institutes of Health)−CIBMTR (Center for International Blood and Marrow Transplant Research) GvHD Task Force”. 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.
  • 13. Sleight BS, Chan KW, Braun TM, Serrano A, Gilman AL. Infliximab for GVHD therapy in children. Bone Marrow Transplant. 2007;40:473-80.
  • 14. Zhao K, Lou R, Huang F, Peng Y, Jiang Z, Huang K, Wu X, Zhang Y, Fan Z, Zhou H, Liu C, Xiao Y, Sun J, Li Y, Xiang P, Liu Q. Immunomodulation effects of mesenchymal stromal cells on acute graft-versus-host disease after hematopoietic stem cell transplantation. Biol Blood Marrow Transplant. 2015;21:97-104.
  • 15. Munneke JM, Spruit MJ, Cornelissen AS, van Hoeven V, Voermans C, Hazenberg MD. The Potential of Mesenchymal Stromal Cells as Treatment for Severe Steroid-Refractory Acute Graft-Versus-Host Disease: A Critical Review of the Literature. Transplantation. 2016;100:2309-14.
  • 16. Gatza E, Reddy P, Choi SW. Prevention and Treatment of Acute Graft-versus-Host Disease in Children, Adolescents, and Young Adults. Biol Blood Marrow Transplant. 2020;26:e101-e12.
  • 17. Ma S, Xie N, Li W, Yuan B, Shi Y, Wang Y. Immunobiology of mesenchymal stem cells. Cell Death Differ. 2014;21:216-25.
  • 18. Chen X, Wang C, Yin J, Xu J, Wei J, Zhang Y. Efficacy of Mesenchymal Stem Cell Therapy for Steroid-Refractory Acute Graft-Versus-Host Disease following Allogeneic Hematopoietic Stem Cell Transplantation: A Systematic Review and Meta-Analysis. PLoS One. 2015;10:e0136991.
  • 19. Cho A, Jantschitsch C, Knobler R. Extracorporeal Photopheresis-An Overview. Front Med (Lausanne). 2018;5:236.
  • 20. Calore E, Marson P, Pillon M, Tumino M, Tison T, Mainardi C, De Silvestro G, Rossin S, Franceschetto G, Carraro E, Pescarin M, Varotto S, Destro R, Gazzola MV, Basso G, Messina C. Treatment of Acute Graft-versus-Host Disease in Childhood with Extracorporeal Photochemotherapy/Photopheresis: The Padova Experience. Biol Blood Marrow Transplant. 2015;21:1963-72.
  • 21. Couriel D, Saliba R, Hicks K, Ippoliti C, de Lima M, Hosing C, Khouri I, Andersson B, Gajewski J, Donato M, Anderlini P, Kontoyiannis DP, Cohen A, Martin T, Giralt S, Champlin R. Tumor necrosis factor-alpha blockade for the treatment of acute GVHD. Blood. 2004;104:649-54.
  • 22. Gonzalez Vicent M, Ramirez M, Sevilla J, Abad L, Diaz MA. Analysis of clinical outcome and survival in pediatric patients undergoing extracorporeal photopheresis for the treatment of steroid‐refractory GVHD. J Pediatr Hematol Oncol. 2010;32:589‐93.
  • 23. Antin JH, Ferrara JL. Cytokine dysregulation and acute graft-versus-host disease. Blood. 1992;80:2964–8.
  • 24. Cavet J, Middleton PG, Segall M, Noreen H, Davies SM, Dickinson AM. Recipient tumor necrosis factor-alpha and interleukin-10 gene polymorphisms associate with early mortality and acute graft-versus-host disease severity in HLA-matched sibling bone marrow transplants. Blood. 1999;94:3941–6.
  • 25. Yang J, Cheuk DK, Ha SY, Chiang AK, Lee TL, Ho MH, Chan GC. Infliximab for steroid refractory or dependent gastrointestinal acute graft-versus-host disease in children after allogeneic hematopoietic stem cell transplantation. Pediatr Transplant. 2012;16:771-8.
  • 26. Ball LM, Bernardo ME, Roelofs H, van Tol MJ, Contoli B, Zwaginga JJ, Avanzini MA, Conforti A, Bertaina A, Giorgiani G, Jol-van der Zijde CM, Zecca M, Le Blanc K, Frassoni F, Egeler RM, Fibbe WE, Lankester AC, Locatelli F. Multiple infusions of mesenchymal stromal cells induce sustained remission in children with steroid-refractory, grade III-IV acute graft-versus-host disease. Br J Haematol. 2013;163:501-9.
  • 27. Kuçi Z, Bönig H, Kreyenberg H, Bunos M, Jauch A, Janssen JW, Škifić M, Michel K, Eising B, Lucchini G, Bakhtiar S, Greil J, Lang P, Basu O, von Luettichau I, Schulz A, Sykora KW, Jarisch A, Soerensen J, Salzmann-Manrique E, Seifried E, Klingebiel T, Bader P, Kuçi S. Mesenchymal stromal cells from pooled mononuclear cells of multiple bone marrow donors as rescue therapy in pediatric severe steroid-refractory graft-versus-host disease: a multicenter survey. Haematologica. 2016;101:985-94.
  • 28. Introna M, Lucchini G, Dander E, Galimberti S, Rovelli A, Balduzzi A, Longoni D, Pavan F, Masciocchi F, Algarotti A, Micò C, Grassi A, Deola S, Cavattoni I, Gaipa G, Belotti D, Perseghin P, Parma M, Pogliani E, Golay J, Pedrini O, Capelli C, Cortelazzo S, D'Amico G, Biondi A, Rambaldi A, Biagi E. Treatment of graft versus host disease with mesenchymal stromal cells: a phase I study on 40 adult and pediatric patients. Biol Blood Marrow Transplant. 2014;20:375-81.
  • 29. Bader P, Kuçi Z, Bakhtiar S, Basu O, Bug G, Dennis M, Greil J, Barta A, Kállay KM, Lang P, Lucchini G, Pol R, Schulz A, Sykora KW, von Luettichau I, Herter-Sprie G, Uddin MA, Jenkin P, Alsultan A, Buechner J, Stein J, Kelemen A, Jarisch A, Soerensen J, Salzmann-Manrique E, Hutter M, Schäfer R, Seifried E, Klingebiel T, Bonig H, Kuçi S. Effective treatment of steroid and therapy-refractory acute graft-versus-host disease with a novel mesenchymal stromal cell product (MSC-FFM). Bone Marrow Transplant. 2018;53:852-62.
  • 30. 30. Rafei H, Kharfan-Dabaja MA, Nishihori T. A Critical Appraisal of Extracorporeal Photopheresis as a Treatment Modality for Acute and Chronic Graft-Versus-Host Disease. Biomedicines. 2017 Oct 11;5(4):60.

The Treatment of Steroid-Refractory Severe Gastrointestinal Acute Graft-Versus-Host Disease in Children after Allogeneic Hematopoietic Stem Cell Transplantation: A Single-Centre Experience

Year 2024, Volume: 46 Issue: 3, 394 - 403, 27.05.2024
https://doi.org/10.20515/otd.1420314

Abstract

Acute graft-versus-host disease is a common complication of allogeneic hematopoietic stem cell transplantation and is a major cause of morbidity and mortality. Systemic steroid therapy is the first-line treatment for acute graft-versus-host disease, although about half of patients will become refractory to treatment. We aimed to evaluate treatment options by reviewing available alternatives for patients with steroid-refractory acute graft-versus-host disease by comparing data from recently published studies. We retrospectively studied the safety and efficacy of treatment in 22 children with steroid‐dependent/refractory acute GVHD between the years 2010 and 2023. Seven (31.8%) out of 22 patients with acute graft-versus-host disease were still alive. The seven surviving patients have been followed for an average of 1141 (±403) days. 15 non-responders with grade III/IV acute graft-versus-host disease died from causes associated with acute graft-versus-host disease and/or other conditions. Among 15 patients who died, the number of patients who received all three treatments, MSC, ECP and infliximab, was 5 (33%). The most common cause of death was infection (8 cases in 15 patients, 53.3%). Other causes of death were gastrointestinal hemorrhages (n=5, 33.3%), and intracranial hemorrhages (n=2, 13.3%). When factors causing morbidity were evaluated, it was observed that three patients developed posterior reversible encephalopathy syndrome, two patients developed hepatic veno-occlusive disease, and one patient developed hypertension. The estimated probability of survival after 1 year was 31.8%, and the median survival was 655 days. We believe that it would be crucial to show the safety and efficacy of novel treatments in comprehensive, randomized clinical trials.

Ethical Statement

The study was approved by Acıbadem University Noninterventional Clinical Research Ethical Committee (Decision no: 2021/20, Date: 14.10.2021).

Supporting Institution

None

References

  • 1. Ferrara JL, Levine JE, Reddy P, Holler E. Graft-versus-host disease. Lancet. 2009;373:1550–61.
  • 2. Carpenter PA, Macmillan ML. Management of acute graft-versus-host disease in children. Pediatr Clin North Am. 2010;57:273–95.
  • 3. Harris AC, Young R, Devine S, Hogan WJ, Ayuk F, Bunworasate U, Chanswangphuwana C, Efebera YA, Holler E, Litzow M, Ordemann R, Qayed M, Renteria AS, Reshef R, Wölfl M, Chen YB, Goldstein S, Jagasia M, Locatelli F, Mielke S, Porter D, Schechter T, Shekhovtsova Z, Ferrara JL, Levine JE. International, multicenter standardization of acute graft-versus-host disease clinical data collection: a report from the Mount Sinai Acute GVHD International Consortium. Biol Blood Marrow Transplant. 2016;22:4–10.
  • 4. Jacobsohn DA. Acute graft‐versus‐host disease in children. Bone Marrow Transplant. 2008;41:215‐21.
  • 5. Faraci M, Caviglia I, Biral E, Morreale G, Giardino S, Garbarino L, Castagnola E, Dini G, Lanino E. Acute graft-versus-host disease in pediatric allogeneic hematopoietic stem cell transplantation. Single-center experience during 10 yr. Pediatr Transplant. 2012;16:887-93.
  • 6. Zeiser R, Blazar BR. Acute Graft-versus-Host Disease - Biologic Process, Prevention, and Therapy. N Engl J Med. 2017;377:2167-79.
  • 7. Winther-Jørgensen S, Nygaard M, Heilmann C, Ifversen M, Sørensen K, Müller K, Masmas T. Feasibility of extracorporeal photopheresis in pediatric patients with graft-versus-host disease after hematopoietic stem cell transplantation. Pediatr Transplant. 2019;23(4):e13416.
  • 8. Malard F, Huang XJ, Sim JPY. Treatment and unmet needs in steroid-refractory acute graft-versus-host disease. Leukemia. 2020;34:1229-40.
  • 9. MacMillan ML, Holtan SG, Rashidi A, DeFor TE, Blazar BR, Weisdorf DJ. Pediatric acute GVHD: clinical phenotype and response to upfront steroids. Bone Marrow Transplant. 2020;55(1):165–171.
  • 10. Penack O, Marchetti M, Ruutu T, Aljurf M, Bacigalupo A, Bonifazi F, Ciceri F, Cornelissen J, Malladi R, Duarte RF, Giebel S, Greinix H, Holler E, Lawitschka A, Mielke S, Mohty M, Arat M, Nagler A, Passweg J, Schoemans H, Socié G, Solano C, Vrhovac R, Zeiser R, Kröger N, Basak GW. Prophylaxis and management of graft versus host disease after stem-cell transplantation for haematological malignancies: updated consensus recommendations of the European Society for Blood and Marrow Transplantation. Lancet Haematol. 2020;7:e157-67.
  • 11. Przepiorka D, Weisdorf D, Martin P, Klingemann HG, Beatty P, Hows J, Thomas ED. 1994 Consensus Conference on Acute GVHD Grading. Bone Marrow Transplant. 1995;15:825-8.
  • 12. Schoemans HM, Lee SJ, Ferrara JL, Wolff D, Levine JE, Schultz KR, Shaw BE, Flowers ME, Ruutu T, Greinix H, Holler E, Basak G, Duarte RF, Pavletic SZ; EBMT (European Society for Blood and Marrow Transplantation) Transplant Complications Working Party and the “EBMT−NIH (National Institutes of Health)−CIBMTR (Center for International Blood and Marrow Transplant Research) GvHD Task Force”. 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.
  • 13. Sleight BS, Chan KW, Braun TM, Serrano A, Gilman AL. Infliximab for GVHD therapy in children. Bone Marrow Transplant. 2007;40:473-80.
  • 14. Zhao K, Lou R, Huang F, Peng Y, Jiang Z, Huang K, Wu X, Zhang Y, Fan Z, Zhou H, Liu C, Xiao Y, Sun J, Li Y, Xiang P, Liu Q. Immunomodulation effects of mesenchymal stromal cells on acute graft-versus-host disease after hematopoietic stem cell transplantation. Biol Blood Marrow Transplant. 2015;21:97-104.
  • 15. Munneke JM, Spruit MJ, Cornelissen AS, van Hoeven V, Voermans C, Hazenberg MD. The Potential of Mesenchymal Stromal Cells as Treatment for Severe Steroid-Refractory Acute Graft-Versus-Host Disease: A Critical Review of the Literature. Transplantation. 2016;100:2309-14.
  • 16. Gatza E, Reddy P, Choi SW. Prevention and Treatment of Acute Graft-versus-Host Disease in Children, Adolescents, and Young Adults. Biol Blood Marrow Transplant. 2020;26:e101-e12.
  • 17. Ma S, Xie N, Li W, Yuan B, Shi Y, Wang Y. Immunobiology of mesenchymal stem cells. Cell Death Differ. 2014;21:216-25.
  • 18. Chen X, Wang C, Yin J, Xu J, Wei J, Zhang Y. Efficacy of Mesenchymal Stem Cell Therapy for Steroid-Refractory Acute Graft-Versus-Host Disease following Allogeneic Hematopoietic Stem Cell Transplantation: A Systematic Review and Meta-Analysis. PLoS One. 2015;10:e0136991.
  • 19. Cho A, Jantschitsch C, Knobler R. Extracorporeal Photopheresis-An Overview. Front Med (Lausanne). 2018;5:236.
  • 20. Calore E, Marson P, Pillon M, Tumino M, Tison T, Mainardi C, De Silvestro G, Rossin S, Franceschetto G, Carraro E, Pescarin M, Varotto S, Destro R, Gazzola MV, Basso G, Messina C. Treatment of Acute Graft-versus-Host Disease in Childhood with Extracorporeal Photochemotherapy/Photopheresis: The Padova Experience. Biol Blood Marrow Transplant. 2015;21:1963-72.
  • 21. Couriel D, Saliba R, Hicks K, Ippoliti C, de Lima M, Hosing C, Khouri I, Andersson B, Gajewski J, Donato M, Anderlini P, Kontoyiannis DP, Cohen A, Martin T, Giralt S, Champlin R. Tumor necrosis factor-alpha blockade for the treatment of acute GVHD. Blood. 2004;104:649-54.
  • 22. Gonzalez Vicent M, Ramirez M, Sevilla J, Abad L, Diaz MA. Analysis of clinical outcome and survival in pediatric patients undergoing extracorporeal photopheresis for the treatment of steroid‐refractory GVHD. J Pediatr Hematol Oncol. 2010;32:589‐93.
  • 23. Antin JH, Ferrara JL. Cytokine dysregulation and acute graft-versus-host disease. Blood. 1992;80:2964–8.
  • 24. Cavet J, Middleton PG, Segall M, Noreen H, Davies SM, Dickinson AM. Recipient tumor necrosis factor-alpha and interleukin-10 gene polymorphisms associate with early mortality and acute graft-versus-host disease severity in HLA-matched sibling bone marrow transplants. Blood. 1999;94:3941–6.
  • 25. Yang J, Cheuk DK, Ha SY, Chiang AK, Lee TL, Ho MH, Chan GC. Infliximab for steroid refractory or dependent gastrointestinal acute graft-versus-host disease in children after allogeneic hematopoietic stem cell transplantation. Pediatr Transplant. 2012;16:771-8.
  • 26. Ball LM, Bernardo ME, Roelofs H, van Tol MJ, Contoli B, Zwaginga JJ, Avanzini MA, Conforti A, Bertaina A, Giorgiani G, Jol-van der Zijde CM, Zecca M, Le Blanc K, Frassoni F, Egeler RM, Fibbe WE, Lankester AC, Locatelli F. Multiple infusions of mesenchymal stromal cells induce sustained remission in children with steroid-refractory, grade III-IV acute graft-versus-host disease. Br J Haematol. 2013;163:501-9.
  • 27. Kuçi Z, Bönig H, Kreyenberg H, Bunos M, Jauch A, Janssen JW, Škifić M, Michel K, Eising B, Lucchini G, Bakhtiar S, Greil J, Lang P, Basu O, von Luettichau I, Schulz A, Sykora KW, Jarisch A, Soerensen J, Salzmann-Manrique E, Seifried E, Klingebiel T, Bader P, Kuçi S. Mesenchymal stromal cells from pooled mononuclear cells of multiple bone marrow donors as rescue therapy in pediatric severe steroid-refractory graft-versus-host disease: a multicenter survey. Haematologica. 2016;101:985-94.
  • 28. Introna M, Lucchini G, Dander E, Galimberti S, Rovelli A, Balduzzi A, Longoni D, Pavan F, Masciocchi F, Algarotti A, Micò C, Grassi A, Deola S, Cavattoni I, Gaipa G, Belotti D, Perseghin P, Parma M, Pogliani E, Golay J, Pedrini O, Capelli C, Cortelazzo S, D'Amico G, Biondi A, Rambaldi A, Biagi E. Treatment of graft versus host disease with mesenchymal stromal cells: a phase I study on 40 adult and pediatric patients. Biol Blood Marrow Transplant. 2014;20:375-81.
  • 29. Bader P, Kuçi Z, Bakhtiar S, Basu O, Bug G, Dennis M, Greil J, Barta A, Kállay KM, Lang P, Lucchini G, Pol R, Schulz A, Sykora KW, von Luettichau I, Herter-Sprie G, Uddin MA, Jenkin P, Alsultan A, Buechner J, Stein J, Kelemen A, Jarisch A, Soerensen J, Salzmann-Manrique E, Hutter M, Schäfer R, Seifried E, Klingebiel T, Bonig H, Kuçi S. Effective treatment of steroid and therapy-refractory acute graft-versus-host disease with a novel mesenchymal stromal cell product (MSC-FFM). Bone Marrow Transplant. 2018;53:852-62.
  • 30. 30. Rafei H, Kharfan-Dabaja MA, Nishihori T. A Critical Appraisal of Extracorporeal Photopheresis as a Treatment Modality for Acute and Chronic Graft-Versus-Host Disease. Biomedicines. 2017 Oct 11;5(4):60.
There are 30 citations in total.

Details

Primary Language English
Subjects Pediatric Hematology and Oncology
Journal Section ORİJİNAL MAKALE
Authors

Utku Aygüneş 0000-0001-9903-2923

Barbaros Karagün 0000-0002-7678-5524

Hatice İlgen Şaşmaz 0000-0001-9361-9838

Ali Bulent Antmen 0000-0001-6058-6021

Gökhan Tümgör 0000-0001-6058-6021

Publication Date May 27, 2024
Submission Date January 15, 2024
Acceptance Date April 4, 2024
Published in Issue Year 2024 Volume: 46 Issue: 3

Cite

Vancouver Aygüneş U, Karagün B, Şaşmaz Hİ, Antmen AB, Tümgör G. The Treatment of Steroid-Refractory Severe Gastrointestinal Acute Graft-Versus-Host Disease in Children after Allogeneic Hematopoietic Stem Cell Transplantation: A Single-Centre Experience. Osmangazi Tıp Dergisi. 2024;46(3):394-403.


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