Acute and Chronic Graft Versus Host Disease (GVHD) Management in the Eastern Mediterranean Region: Result of the Worldwide Network for Blood & Marrow Transplantation (WBMT) Global GvHD Survey.
Notice bibliographique
Résumé
Introduction Despite the approval of multiple therapies for acute and chronic GVHD over the past few years, it continues to be an area of need, particularly in cases of refractory GVHD where options remain limited. Objective To understand the current practices of GVHD management in the Eastern Mediterranean (EM) Region. Methodology As part of the WBMT global GVHD survey, a 46-item questionnaire was distributed electronically to the hematopoietic cell transplantation (HCT) programs in the EM region between December 2022 and June 2023. The questionnaire addressed different aspects of acute and chronic GVHD management and supportive care. Results The survey was completed by 30 programs in 26 different institutions. Responses were from 11 countries, with ten centers participating from Saudi Arabia. Additionally, we received three responses from centers in Pakistan and Egypt, two from Iran, Algeria, Lebanon, Jordan, Oman, and Morocco, and one from Tunisia and Kuwait. Regarding acute GVHD (aGVHD) management, the most commonly reported initial reported prednisone dose was 1 mg/kg/day for grade IIa and 2 mg/kg/day for grade IIb. Most programs report continuing immunosuppressive therapy along with prednisone or reintroducing it if GVHD develops after its cessation. Ruxolitinib was the most frequently identified medication as a possible second-line treatment by 83% of the programs. This was followed by calcineurin inhibitors (47%), high-dose steroids (>2 mg/kg, 43%), MMF (40%), and ECP (40%). The frequencies were similar across disease-specific GvHD. Two (7%) programs reported the inclusion of steroid-refractory aGVHD patients in clinical trials, and 30% reported having no standard operating procedure (SOP). For chronic GVHD (cGVHD) management, systemic steroids are used for initial management of mild cGVHD not accessible by topical treatment and moderate/severe disease with a most commonly used initial dose of 0.5-1 and >1 mg/kg/day, respectively. Twenty-one (70%) programs use another agent in addition to steroids in patients who develop moderate/severe cGVHD patients while off immunosuppressive therapy. For steroid-refractory cGVHD, most programs selected multiple options in the second line setting, with the most frequently selected options being ruxolitinib (80%), calcineurin inhibitors (67%), MMF (53%), imatinib (53%), ECP (50%), rituximab (47%) and ibrutinib (40%). No program has reported the use of belumosudil. Three (10%) centers reported including steroid-refractory cGVHD patients in clinical trials, and 13 centers (43%) reported having no SOP for their management. Additionally, only 6 (20%) programs reported having a multi-disciplinary cGVHD team. Conclusion Although most practices in the EM region align with current guidelines, our results highlight the need to increase access to clinical trials and multi-disciplinary supporting teams.
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Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».