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.
Division of Hematology, Azienda Ospedaliera Universitaria Ospedali Riuniti, Ancona, Italy.
Bone Marrow Transplant. 2018 Jan;53(1):58-63. doi: 10.1038/bmt.2017.223. Epub 2017 Oct 30.
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.
已经发布了一些关于慢性移植物抗宿主病（cGvHD）管理的指南，但临床实践仍然具有挑战性。意大利骨髓移植组（GITMO）计划进行一项关于 cGvHD 的前瞻性观察性研究，该研究得到了专门软件的支持，包括更新的建议。鉴于这项研究，进行了两项调查，重点关注 cGvHD 的管理和 cGvHD 的辅助治疗，以解决当前的“实际情况”。这两项调查都发送给了在意大利进行同种异体移植的所有 57 个 GITMO 中心；接受采访的中心的回复率分别为 57%和 66%。第一项调查显示出了很大的差异，特别是在类固醇难治性 cGvHD 方面，尽管体外光分离吸附术是这种情况下最推荐的治疗方法。另一个具有挑战性的问题是类固醇减量的策略：我们的调查显示出很大的差异，这种分歧可能是在评估前瞻性研究结果时的一个真正的偏差。至于第二项调查，结果表明许多中心的辅助治疗没有标准化。所有接受调查的中心都报告说，强烈需要规范 cGvHD 的管理，并参与前瞻性试验。在开始观察性和/或干预性研究之前，应该鼓励详细了解当前的实践情况。
