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Treatment of cutaneous and/or soft tissue manifestations of corticosteroids refractory chronic graft versus host disease ( cGVHD ) by a total nodal irradiation (TNI)
Author(s) -
Peyraga Guillaume,
Lizee Thibaut,
Gustin Pierre,
ClementColmou Karen,
Di Bartolo Christelle,
Supiot Stephane,
Mahe MarcAndre,
François Sylvie,
Mege Martine
Publication year - 2017
Publication title -
clinical transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 76
eISSN - 1399-0012
pISSN - 0902-0063
DOI - 10.1111/ctr.12923
Subject(s) - medicine , refractory (planetary science) , graft versus host disease , surgery , clinical trial , transplantation , physics , astrobiology
The management of corticosteroids refractory chronic graft versus host disease ( cGVHD ) remains controversial. Retrospective analysis of patients treated at the Integrated Center of Oncology by total nodal irradiation ( TNI ) was performed to evaluate its therapy potency. TNI delivers a dose of 1 Gy in a single session. The delimitation of the fields is clinical (upper limit: external auditory meatus; lower limit: mid‐femur). No pre‐therapeutic dosimetry scanner was necessary. Evaluation of the efficacy was by clinical measures at 6 months after the treatment. Twelve patients were treated by TNI between January 2010 and December 2013. TNI was used in second‐line treatment or beyond. The median time between allograft and TNI was 31.2 months, and the median time between the first manifestations of cGVHD and TNI was about 24.2 months. Of the 12 patients, nine had a clinical response at 6 months (75%), including five complete clinical responses (41.6%). Five patients could benefit from a reduction of corticosteroid doses. Three patients had hematologic toxicity. TNI could be considered as an option for the treatment of a cutaneous and/or soft tissues corticosteroids refractory cGVHD . However, prospective randomized and double‐blind trials remain essential to answer the questions about TNI safety and effectiveness.