Treatment of cutaneous and/or soft tissue manifestations of corticosteroids refractory chronic graft versus host disease (cGVHD) by a total nodal irradiation (TNI)

• Published in: Clinical transplantation 2017-04, Vol.31 (4), p.np-n/a
• Main Authors: Peyraga, Guillaume, Lizee, Thibaut, Gustin, Pierre, Clement‐Colmou, Karen, Di Bartolo, Christelle, Supiot, Stephane, Mahe, Marc‐Andre, François, Sylvie, Mege, Martine
• Format: Article
• Language: English
• Subjects: Adrenal Cortex Hormones - pharmacology; Adult; allogeneic hematopoietic stem cell transplantation; Chronic Disease; chronic graft versus host disease; Drug Resistance, Neoplasm - radiation effects; Female; Follow-Up Studies; Graft vs Host Disease - etiology; Graft vs Host Disease - radiotherapy; Hematopoietic Stem Cell Transplantation - adverse effects; Humans; immunosuppressive therapy; Lymph Nodes - radiation effects; Male; Middle Aged; Prognosis; Retrospective Studies; second‐line treatment; Skin Diseases - etiology; Skin Diseases - radiotherapy; Soft Tissue Neoplasms - etiology; Soft Tissue Neoplasms - radiotherapy; thoraco‐abdominal irradiation; total lymphoid irradiation; total nodal irradiation; Transplantation, Homologous; Young Adult
• ISSN: 0902-0063; 1399-0012
• DOI: 10.1111/ctr.12923

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.