Allogeneic hematopoietic stem cell transplantation; Cellules stromales mésenchymateuses; Extracorporeal photopheresis; Fecal microbiota transplantation; Graft-versus host disease; Maladie du greffon contre l’hôte; Mesenchymal stromal cells; Photophérèse extracorporelle; Ruxolitinib; Transplantation de cellules souches hématopoïétiques allogéniques; Transplantation de microbiote fécal; Hematology; Radiology, Nuclear Medicine and Imaging; Oncology; Cancer Research
Abstract :
[en] Acute graft-versus-host disease (GVHDa) is one of the leading causes of morbidity and mortality after allogeneic hematopoietic stem cell transplant (HSCT) patients. While the first-line consensus treatment has been based on systemic corticosteroid therapy for many years, ruxolitinib has recently been approved and has become the standard second-line treatment. Nevertheless, the effectiveness of ruxolitinib remains limited to 40 % of cortico-resistant patients, raising the crucial question of selecting a third-line treatment. Among the therapeutic modalities described, this workshop selected fecal microbiota transplantation (FMT), mesenchymal stromal cells (MSC) injection, and extracorporeal photopheresis (ECP) as the most promising or with a benefit/risk balance that favors their prescription at this stage. The workshop also highlighted the importance of research aimed at identifying markers or score calculations that guide toward a risk-adapted approach as early as possible. To date, aside from calprotectin, no marker or score is routinely used, but all are the subject of intense research. Finally, measures associated with specific treatment remain crucial, and new developments in dietary contributions, infection prophylaxis, and tissue regeneration are also addressed.
Disciplines :
Hematology
Author, co-author :
Coman, Tereza; Service d'hématologie, Gustave-Roussy, 114, rue Edouard-Vaillant, 94805 Villejuif, France. Electronic address: tereza.coman@gustaveroussy.fr
Andreozzi, Fabio; Service d'hématologie H.U.B., Institut Jules-Bordet, rue Meylemeersch 90, 1070 Bruxelles, Belgium
Bay, Jaques-Olivier; Service de thérapie cellulaire et d'hématologie clinique adulte, CHU Clermont-Ferrand, 1, place Lucie-Aubrac, 63000 Clermont-Ferrand, France
Cornillon, Jérôme; Département d'hématologie clinique et de thérapie cellulaire, CHU de Saint-Étienne, 108, avenue Albert-Raimond, 42000 Saint-Étienne Cedex, France
Guillaume, Thierry; Service d'hématologie, CHU de Nantes Hôtel-Dieu, 1, place Alexis-Ricordeau, 44000 Nante, France
Hamzy, Fati; Service d'hématologie et thérapie cellulaire, hôpital Cheikh Zaid Universitaire International, cité Al Irfane Hay Ryad, avenue Allal Al Fassi, 10000 Rabat, Maroc
Souchet, Laetitia; Service d'hématologie clinique, hôpital Pitié Salpêtrière, 47, boulevard de l'Hôpital, 75013 Paris, France
Turlure, Pascal; Service d'hématologie clinique, CHU Dupuytren Limoges, 2, avenue Martin Luther-King, 87000 Limoges, France
Marçais, Ambroise; Service d'hématologie, CHU Necker, 149, rue de Sèvres, 75015 Paris, France
Beguin, Yves ; Université de Liège - ULiège > Département des sciences cliniques
Bulabois, Claude Eric; Hématologie soins intensifs, CHU Grenoble Alpes, Grenoble, France
Daghri, Sanae; Service d'hématologie et greffe, hôpital Universitaire International Cheikh-Zaïd, Cité Al-Irfane-Hay Ryad, avenue Allal-al-Fassi, 10000 Rabat, Maroc
Huynh, Anne; Service d'hématologie clinique et de thérapie cellulaire, CHU/IUCT-Oncopole, 31059 Toulouse, France
Magro, Leonardo; Service des maladies du sang, unité d'allogreffes, hôpital Huriez, CHRU Lille, rue M.Polonovski, 59037 Lille, France
Chalandon, Yves; Service d'hématologie, département d'oncologie, hôpitaux universitaire de Genève (HUG), faculté de médecine, université de Genève, Genève, Suisse. Electronic address: yves.chalandon@hug.ch
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