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Published on: March 17, 2020
TLI in refractory chronic GVHD
R Devillier1, L Castagna, L Gonzague
1Department of Hematology, Transplantation Program, Institut Paoli Calmettes, Marseille, France.
Insights
Total lymphoid irradiation (TLI) shows promise for treating refractory chronic graft-versus-host disease (cGVHD) in transplant patients. TLI offers a potential alternative, improving survival outcomes in this challenging patient population.
Area of Science:
- Hematology
- Immunology
- Oncology
Background:
- Refractory chronic graft-versus-host disease (cGVHD) is a significant cause of morbidity post-transplantation.
- Current treatment options lack a standardized care approach, necessitating alternative therapies.
Purpose of the Study:
- To evaluate the efficacy of Total Lymphoid Irradiation (TLI) in patients with corticosteroid-refractory cGVHD.
- To assess response rates and clinical outcomes following TLI treatment.
Main Methods:
- Retrospective analysis of 31 patients with refractory cGVHD treated with TLI between 2000 and 2007.
- Evaluation of response based on decreased corticosteroid doses or discontinued immunosuppressive agents.
- Assessment of GVHD-related mortality and overall survival (OS).
Main Results:
- 45% of patients achieved an objective response to TLI.
- 25% of patients were free of cGVHD at long-term follow-up.
- TLI response significantly improved 5-year GVHD-related mortality (14% vs. 42%, P=0.038).
Conclusions:
- TLI demonstrates a promising response rate in heavily pretreated patients with refractory cGVHD.
- TLI may serve as a viable alternative treatment option for corticosteroid-refractory cGVHD.
- Further investigation into TLI's role in managing cGVHD is warranted.
Abstract:
Refractory chronic GVHD (cGVHD) remains a major cause of morbidity after transplantation. Many drugs are used but there is no consensus on the standard of care. We investigated the efficacy of TLI in corticosteroid-refractory cGVHD. We analyzed retrospectively 31 patients receiving one or more TLI session for refractory cGVHD from 2000 to 2007. The main objective was to evaluate the response rate after TLI. Decreased corticosteroid doses and/or discontinued immunosuppressive agents were considered to be surrogate markers of response. All but one patient presented with severe cGVHD at the time of TLI. The median number of previous immunosuppressive treatment lines was 3 (range: 2-4). Fourteen patients (45%) achieved an objective response after TLI and 8 (25%) were cGVHD free at long-term follow-up. In all, 5 (29%) of the 17 nonresponsive patients did not show the features of progressive cGVHD and could decrease the amount of immunosuppressive drugs taken. Response after TLI significantly improved 5-year GVHD-related mortality (14% vs 42%, P=0.038) but not OS (58%vs 64% P=0.27). Regarding the promising response rate in this heavily pretreated population, we reasoned that TLI could be an alternative treatment for corticosteroid-refractory cGVHD.
