Chronic graft-vs-host disease (GVHD) is the most common complication of allogeneic hematopoietic stem cell transplantation (HSCT). Patients with chronic GVHD can have infections and a variety of complications due to multiple abnormalities of their reconstructed immune systems. Infection is the most common cause of death in patients with chronic GVHD. Chronic GHVD may also compromise a patient’s quality of life as a result of long-term immunosuppressive therapy and the symptoms of GVHD itself. Chronic GVHD is the major determinant in the survival and quality of life of patients after allogeneic HSCT.
The primary strategy to prevent GVHD is the use of cyclosporine and tacrolimus in combination with other immunosuppressants. Despite these prophylactic therapies, GVHD still develops in 30%-80% of patients. One of the newer potentially promising agents is Gleevec. It is especially attractive for patients transplanted for CML or Philadelphia chromosome positive ALL, where Gleevec has an anti leukemia effect as well.
There are two small phase II studies and a restrospective review as well as case series and reports. In the consensus paper published by the Consensus Conference of Clinical Practice in Chronic GVHD wrote:“Use in greater than second-line treatment justified” based upon “Evidence from opinions of respected authorities based on clinical experience, descriptive studies or reports from expert committees”. A 2012 guideline (Dinghan et al) recommends it for second line treatment.
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