Tags

Type your tag names separated by a space and hit enter

Corticosteroids for preventing graft-versus-host disease after allogeneic myeloablative stem cell transplantation.

Abstract

BACKGROUND

Despite ongoing progress, acute and chronic GvHD still represent major drawbacks in the context of allogeneic myeloablative haematopoietic stem cell transplantation (HSCT) due to their high morbidity and mortality. Corticosteroids are used as first-line treatment of acute and chronic GvHD. However, their role for preventing GvHD is unclear as the published study results are controversial.

OBJECTIVES

To determine the effectiveness of corticosteroids used for the prophylaxis of GvHD in adults following allogeneic myeloablative HSCT. in improving overall survival, disease-free survival, relapse incidence, non-relapse mortality, acute GvHD grade I to IV, II to IV and III to IV, chronic GvHD, incidence of infectious complications, other adverse effects and cause of deaths.

SEARCH STRATEGY

We searched the Cochrane Haematological Malignancies Group trials register, CENTRAL (The Cochrane Library Issue 2, 2004), MEDLINE (January 1999 to February 2006), EMBASE (January 1999 to 2004), LILACS covering publications until 2004, as well as handsearched conference proceedings, including citations until 2005.

SELECTION CRITERIA

Randomised controlled trials (RCT) comparing the addition of corticosteroids to a GvHD prophylaxis regimen in adult patients having undergone allogeneic myeloablative HSCT were included into the review. All types and stages of the underlying disease as well as all types of possible HLA-matching were considered.

DATA COLLECTION AND ANALYSIS

Trial eligibility and quality assessment, data extraction and analysis were done in duplicate.

MAIN RESULTS

Five RCTs involving 604 people were included. The pooled results revealed that the addition of corticosteroids reduces statistically significant the risk for acute GvHD grade I to IV (HR 0.58; 95% CI 0.45 to 0.76) and II to IV (HR 0.69; 95% CI 0.51 to 0.92). No evidence was found that it has any clinical relevance on overall survival (HR 0.99; 95% CI 0.79 to 1.25) or disease-free survival (HR 0.95; 95% CI 0.74 to 1.23). As well, no statistically significant influence was found for acute GvHD grade III to IV (HR 0.78; 95% CI 0.52 to 1.15), chronic GvHD (HR 1.21;95% CI 0.89 to 1.65]), relapse incidence (HR 0.82; 95% CI 0.57 to 1.18) or non-relapse mortality (HR 0.88;95% CI 0.61 to 1.26). No clear evidence was found that the rate of infectious complications (under the concomitant use of antiviral or antibacterial medication or both) increases with the addition of corticosteroids. With respect to the other outcomes no significant differences could be detected.

AUTHORS' CONCLUSIONS

The addition of corticosteroids reduces the incidences of acute GvHD grade I to IV and II to IV. This reduction, however, did not show any effect on overall survival and disease-free survival. Further randomised controlled studies are needed to evaluate if the timing of steroid administration has a significant influence on the outcome; data on quality of life should be assessed systematically.

Authors+Show Affiliations

Cochrane Haematological Malignancies Group - Department of Internal Medicine 1, University Hospital of Cologne, Kerpener Str. 62, Cologne, Germany, 50924. s.quellmann@email.deNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Meta-Analysis
Review
Systematic Review

Language

eng

PubMed ID

18646116

Citation

Quellmann, Susanne, et al. "Corticosteroids for Preventing Graft-versus-host Disease After Allogeneic Myeloablative Stem Cell Transplantation." The Cochrane Database of Systematic Reviews, 2008, p. CD004885.
Quellmann S, Schwarzer G, Hübel K, et al. Corticosteroids for preventing graft-versus-host disease after allogeneic myeloablative stem cell transplantation. Cochrane Database Syst Rev. 2008.
Quellmann, S., Schwarzer, G., Hübel, K., Greb, A., Engert, A., & Bohlius, J. (2008). Corticosteroids for preventing graft-versus-host disease after allogeneic myeloablative stem cell transplantation. The Cochrane Database of Systematic Reviews, (3), CD004885. https://doi.org/10.1002/14651858.CD004885.pub2
Quellmann S, et al. Corticosteroids for Preventing Graft-versus-host Disease After Allogeneic Myeloablative Stem Cell Transplantation. Cochrane Database Syst Rev. 2008 Jul 16;(3)CD004885. PubMed PMID: 18646116.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Corticosteroids for preventing graft-versus-host disease after allogeneic myeloablative stem cell transplantation. AU - Quellmann,Susanne, AU - Schwarzer,Guido, AU - Hübel,Kai, AU - Greb,Alexander, AU - Engert,Andreas, AU - Bohlius,Julia, Y1 - 2008/07/16/ PY - 2008/7/23/pubmed PY - 2008/10/16/medline PY - 2008/7/23/entrez SP - CD004885 EP - CD004885 JF - The Cochrane database of systematic reviews JO - Cochrane Database Syst Rev IS - 3 N2 - BACKGROUND: Despite ongoing progress, acute and chronic GvHD still represent major drawbacks in the context of allogeneic myeloablative haematopoietic stem cell transplantation (HSCT) due to their high morbidity and mortality. Corticosteroids are used as first-line treatment of acute and chronic GvHD. However, their role for preventing GvHD is unclear as the published study results are controversial. OBJECTIVES: To determine the effectiveness of corticosteroids used for the prophylaxis of GvHD in adults following allogeneic myeloablative HSCT. in improving overall survival, disease-free survival, relapse incidence, non-relapse mortality, acute GvHD grade I to IV, II to IV and III to IV, chronic GvHD, incidence of infectious complications, other adverse effects and cause of deaths. SEARCH STRATEGY: We searched the Cochrane Haematological Malignancies Group trials register, CENTRAL (The Cochrane Library Issue 2, 2004), MEDLINE (January 1999 to February 2006), EMBASE (January 1999 to 2004), LILACS covering publications until 2004, as well as handsearched conference proceedings, including citations until 2005. SELECTION CRITERIA: Randomised controlled trials (RCT) comparing the addition of corticosteroids to a GvHD prophylaxis regimen in adult patients having undergone allogeneic myeloablative HSCT were included into the review. All types and stages of the underlying disease as well as all types of possible HLA-matching were considered. DATA COLLECTION AND ANALYSIS: Trial eligibility and quality assessment, data extraction and analysis were done in duplicate. MAIN RESULTS: Five RCTs involving 604 people were included. The pooled results revealed that the addition of corticosteroids reduces statistically significant the risk for acute GvHD grade I to IV (HR 0.58; 95% CI 0.45 to 0.76) and II to IV (HR 0.69; 95% CI 0.51 to 0.92). No evidence was found that it has any clinical relevance on overall survival (HR 0.99; 95% CI 0.79 to 1.25) or disease-free survival (HR 0.95; 95% CI 0.74 to 1.23). As well, no statistically significant influence was found for acute GvHD grade III to IV (HR 0.78; 95% CI 0.52 to 1.15), chronic GvHD (HR 1.21;95% CI 0.89 to 1.65]), relapse incidence (HR 0.82; 95% CI 0.57 to 1.18) or non-relapse mortality (HR 0.88;95% CI 0.61 to 1.26). No clear evidence was found that the rate of infectious complications (under the concomitant use of antiviral or antibacterial medication or both) increases with the addition of corticosteroids. With respect to the other outcomes no significant differences could be detected. AUTHORS' CONCLUSIONS: The addition of corticosteroids reduces the incidences of acute GvHD grade I to IV and II to IV. This reduction, however, did not show any effect on overall survival and disease-free survival. Further randomised controlled studies are needed to evaluate if the timing of steroid administration has a significant influence on the outcome; data on quality of life should be assessed systematically. SN - 1469-493X UR - https://www.unboundmedicine.com/medline/citation/18646116/Corticosteroids_for_preventing_graft_versus_host_disease_after_allogeneic_myeloablative_stem_cell_transplantation_ L2 - https://doi.org/10.1002/14651858.CD004885.pub2 DB - PRIME DP - Unbound Medicine ER -