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Review
. 2020 Dec 8:11:2040620720977039.
doi: 10.1177/2040620720977039. eCollection 2020.

Adverse events in second- and third-line treatments for acute and chronic graft- versus-host disease: systematic review

Vladica M Velickovic  1 , Emily McIlwaine  1 , Rongrong Zhang  1 , Tim Spelman  2
Affiliations
Review

Adverse events in second- and third-line treatments for acute and chronic graft- versus-host disease: systematic review

Vladica M Velickovic et al. Ther Adv Hematol. .

Abstract

Background: Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is associated with an increased risk of graft-versus-host disease (GvHD), a strong prognostic predictor of early mortality within the first 2 years following allo-HSCT. The objective of this study was to describe the harm outcomes reported among patients receiving second- and third-line treatment as part of the management for GvHD via a systematic literature review.

Methods: A total of 34 studies met the systematic review inclusion criteria, reporting adverse events (AEs) across 12 different second- and third-line therapies.

Results: A total of 14 studies reported AEs across nine different therapies used in the treatment of acute GvHD (aGvHD), 17 studies reported AEs of eight different treatments for chronic GvHD (cGvHD) and 3 reported a mixed population. Infections were the AE reported most widely, followed by haematologic events and laboratory abnormalities. Reported infections per patient were lower under extracorporeal photopheresis (ECP) for aGvHD (0.267 infections per patient over 6 months) relative to any of the therapies studied (ranging from 0.853 infections per patient per 6 months under etanercept up to 1.998 infections per patient on inolimomab).

Conclusion: The reported incidence of infectious AEs in aGvHD and grade 3-5 AEs in cGvHD was lower on ECP compared with pharmaceutical management.

Keywords: extracorporeal photopheresis; graft versus host disease; systematic review.

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Conflict of interest statement

Conflict of interest statement: VV, EM, RZ, and TS are/were employees of Synergus AB – health economics and market access consulting company, which received a grant from Mallinckrodt Pharmaceuticals to perform the study. Mallinckrodt reviewed the manuscript only to verify accuracy of product mentions.

Figures

Figure 1.
Figure 1.
PRISMA flow chart of articles included in this systematic review. CENTRAL, Cochrane central register of controlled trials; GvHD, graft-versus-host disease; PRISMA, preferred reporting items for systematic reviews and meta-analyses; RCTs, randomised controlled trials.
See this image and copyright information in PMC

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