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Bone Marrow Transplant. 2018 Jan;53(1):58-63. doi: 10.1038/bmt.2017.223. Epub 2017 Oct 30.

'Real-life' report on the management of chronic GvHD in the Gruppo Italiano Trapianto Midollo Osseo (GITMO).

Author information

1
Department of Molecular Biotechnology and Health Sciences, University of Torino, and Department of Oncology, AOU Città della Salute e della Scienza di Torino, Torino, Italy.
2
Division of Hematology, Azienda Ospedaliera Universitaria Ospedali Riuniti, Ancona, Italy.
3
Division of Hematology, Azienda Ospedaliera S. Croce e Carle, Cuneo, Italy.
4
UOC Ematology and TCSE, AOU Federico II, Napoli, Italy.
5
UOC Oncoematology Pediatrica, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
6
Division of Hematology and Stem Cell Transplantation, Ospedale Mazzoni, Ascoli Piceno, Italy.
7
Division of Hematology, University Hospital Sant'Orsola-Malpighi, Bologna, Italy.
8
Ospedale di Riferimento Regionale Businco, AO Brotzu, Cagliari, Italy.
9
Divisione di Ematologia, Ospedale di Lecce, Lecce, Italy.
10
Division of Hematology, Ospedale Humanitas, Rozzano, Italy.
11
Department of Women's and Children's Health, Clinic of Pediatric Hemato-Oncology, University Hospital of Padova, Padova, Italy.
12
Hematology and Bone Marrow Transplant Unit, Ospedale Centrale di Bolzano, Bolzano, Italy.
13
UOC di Ematologia con TMO, Ospedale San Carlo, Potenza, Italy.
14
Divisione di Ematologia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
15
Hematology Unit, Arcispedale S Maria Nuova-IRCCS, Reggio Emilia, Italy.
16
U.O.C. Ematologia e Trapianto di Cellule Staminali Emopoietiche, Ospedale Mazzoni, Ascoli Piceno, Italy.
17
Department of Pediatric Hematology-Oncology, IRCCS G. Gaslini, Genova, Italy.
18
Hematology and Stem Cell Transplant Unit, Azienda Ospedaliera Bianchi Melacrino Morelli, Reggio Calabria, Italy.
19
Department of Hematology, Bone Marrow Transplant Unit, University of Firenze, Firenze, Italy.
20
Department of 'Cellular Biotechnologies and Hematology', Azienda Policlinico Umberto I, Università La Sapienza, Roma, Italy.
21
Hematology and Bone Marrow Transplant Unit, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy.
22
Hematology and Bone Marrow Transplant Unit, Azienda Policlinico Vittorio Emanuele, Catania, Italy.
23
Hematology-BMT Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico-University of Milan, Milano, Italy.
24
Dipartimento di Ematologia, Università di Bari, Bari, Italy.
25
Azienda Ospedaliera-Universitaria di Udine, DISM Università di Udine, Udine, Italy.
26
Hematology, AO SS Antonio e Biagio e C Arrigo, Alessandria, Italy.
27
Hematology and Bone Marrow Transplant Unit, Ospedale San Bortolo, Vicenza, Italy.
28
BMT Unit, MBBM Foundation, Paediatric Department, University of Milano-Bicocca, San Gerardo Hospital, Monza, Italy.
29
Unità Terapia Intensiva Ematologica per il Trapianto Emopoietico, Ospedale Civile, Pescara, Italy.
30
Divisione di Ematologia, Ospedale San Camillo, Roma, Italy.
31
Unit of Blood Disease and Stem Cell Transplantation, Department of Clinical and Experimental Sciences, University of Brescia, AO Spedali Civili di Brescia, Brescia, Italy.
32
Molecular Hematology Laboratory, IRCCS San Raffaele Scientific Institute, Milano, Italy.
33
Department of Medicine, Section of Hematology, University of Verona, Verona, Italy.
34
Pediatric Onco-Hematology and Stem Cell Transplant Division, AO Città della Salute e della Scienza di Torino, Torino, Italy.

Abstract

Several guidelines have been published about management of chronic GvHD (cGvHD), but the clinical practice still remains demanding. The Gruppo Italiano Trapianto di Midollo Osseo (GITMO) has planned a prospective observational study on cGvHD, supported by a dedicated software, including the updated recommendations. In view of this study, two surveys have been conducted, focusing the management of cGvHD and ancillary therapy in cGvHD, to address the current 'real life' situation. The two surveys were sent to all 57 GITMO centers, performing allografting in Italy; the response rate was 57% and 66% of the interviewed centers, respectively. The first survey showed a great disparity especially regarding steroid-refractory cGvHD, although extracorporeal photo-apheresis resulted as the most indicated treatment in this setting. Another challenging issue was the strategy for tapering steroid: our survey showed a great variance, and this disagreement could be a real bias in evaluating outcomes in prospective studies. As for the second survey, the results suggest that the ancillary treatments are not standardized in many centers. All responding centers reported a strong need to standardize management of cGvHD and to participate in prospective trials. Before starting observational and/or interventional studies, a detailed knowledge of current practice should be encouraged.

PMID:
29084200
DOI:
10.1038/bmt.2017.223
[Indexed for MEDLINE]
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