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Extracorporeal Photopheresis in Acute and Chronic Steroid-refractory Graft-versus-host Disease: an Evolving Treatment Landscape
Abstract: Patients with steroid-refractory graft-versus-host disease (GvHD) are known to have a poor prognosis and for decades no approved drug has been available to treat this serious condition. Although ruxolitinib, a selective Janus kinase (JAK)1/2 inhibitor demonstrated significantly higher response rates in randomized trials compared to the best available therapy, and thus, is of benefit in both acute as well as chronic GvHD, there is an urgent medical need to improve results, such as durability of responses, response in eye, liver and lung manifestations and reduction of infectious complications. In this "Review" article we would like to offer strategies for improving treatment results in patients with steroid-refractory GvHD by combining ruxolitinib with extracorporeal photopheresis (ECP), a leukapheresis-based immunomodulatory treatment frequently applied in T-cell mediated immune disease including GvHD. Our article explores key published evidence supporting the clinical efficacy of both ruxolitinib and ECP in the treatment of GvHD and highlights their potentially complementary mechanisms of action
Pathophysiology of Gastrointestinal Acute Graft-versus-host Disease and the Potential Role of Glucagon-like Peptide 2
Abstract: Acute graft-versus-host disease (aGVHD) is a life-threatening complication after allogeneic haematopoietic cell transplantation, with gastrointestinal (GI) tract involvement (GI aGVHD) being one of the leading causes of morbidity and mortality. Whilst systemic steroids are the standard first-line treatment for aGVHD, approximately 50% of patients become steroid refractory (SR), which is associated with poor outcomes. Existing options for SR-GVHD are limited, and there is a significant unmet need for new non-immunosuppressive treatment approaches in patients with GI aGVHD. Here, we review newer concepts in the pathogenesis of GI aGVHD and present the evidence for the role of glucagon-like peptide 2 (GLP-2) in maintaining and protecting GI epithelial cells, including the enterocytes, intestinal stem cells and Paneth cells, which are direct targets of aGVHD. Finally, we discuss the therapeutic rationale for GLP-2 treatment as a tissue regeneration approach and the potential use of the novel GLP-2 analogue apraglutide as an adjunctive treatment for GI aGVHD
The EBMT Handbook
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Stem Cells and Their Potential for Clinical Application
The NATO-ASI conference Stem Cells and Their Potential for Clinical Application featured cutting-edge presentations ranging from laboratory research findings to the latest therapeutic applications. This book features contributions from many of the leading international scientists from North America and Western and Eastern Europe who participated in this conference. Articles cover a broad range of hot topics in stem cell and leukemia research.
HIV/AIDS and Children in the English Speaking Caribbean
Examine the biopsychosocial, environmental, spiritual, and policy issues that affect HIV/AIDS prevention/service delivery issues for Caribbean youth!This groundbreaking book provides an overview and informed discussion of HIV/AIDS as it affects children and adolescents in Antigua, Barbados, Grenada, Jamaica, and The Republic of Trinidad and Tobago. With contributions from noted HIV/AIDS experts in the region, it examines the biopsychosocial, environmental, spiritual, and policy issues that impact HIV/AIDS prevention/service delivery issues for Caribbean youth. HIV/AIDS and Children in the English Speaking Caribbean breaks the silence on this subject that has existed throughout the Caribbean-...
The EBMT Handbook
This Open Access edition of the European Society for Blood and Marrow Transplantation (EBMT) handbook addresses the latest developments and innovations in hematopoietic stem cell transplantation and cellular therapy. Consisting of 93 chapters, it has been written by 175 leading experts in the field. Discussing all types of stem cell and bone marrow transplantation, including haplo-identical stem cell and cord blood transplantation, it also covers the indications for transplantation, the management of early and late complications as well as the new and rapidly evolving field of cellular therapies. This book provides an unparalleled description of current practices to enhance readers' knowledge and practice skills. This work was published by Saint Philip Street Press pursuant to a Creative Commons license permitting commercial use. All rights not granted by the work's license are retained by the author or authors.
