Current and Recent Advances in the Treatment of Steroid Refractory Acute Graft versus Host Disease

Authors

  • Nguyen Anh Nguyen Mentor High School
  • Dr. Meaghan McGeary

DOI:

https://doi.org/10.47611/jsrhs.v13i2.6571

Keywords:

Biomedical and Health Sciences, Immunology, Graft versus Host disease, Steroid refractory Acute Graft versus Host Disease, Treatments for Steroid refractory Acute Graft versus Host disease

Abstract

Acute Graft versus Host Disease (aGVHD) is a life-threatening complication that occurs within the first 100 days after an allogeneic hematopoietic stem cell transplantation (allo-HSCT). In order to treat aGVHD, corticosteroids are commonly used as first-line therapy. Nevertheless, their complete response rate is only around 50%. The rest of the patients became steroid-refractory (SR), and the death rate of steroid-refractory aGVHD (SR-aGVHD) patients was more than 90%, which shows that there is a pressing need for a cure for this condition. Hence, this review aims to highlight the currently available and recent advancements in the field of treatments for SR-aGVHD. Despite the deaths, relapses and infections caused by SR-aGVHD, there are significant innovations, specifically in the area of using stem cells as a treatment. Ultimately, this literature has reflected on the development of SR-aGVHD treatments over the years, indicated by the rise in the number and the quality of ongoing and completed trials.

Downloads

Download data is not yet available.

References or Bibliography

Villarreal, C. D., Alanis, J. C., Pérez, J. C., & Candiani, J. O. (2016). Cutaneous graft-versus-host disease after hematopoietic stem cell transplant - a review. Anais brasileiros de dermatologia, 91(3), 336–343. https://doi.org/10.1590/abd1806-4841.20164180

Talib, S., & Shepard, K. A. (2020). Unleashing the cure: Overcoming persistent obstacles in the translation and expanded use of hematopoietic stem cell-based therapies. Stem cells translational medicine, 9(4), 420–426. https://doi.org/10.1002/sctm.19-0375

Giralt, S., & Bishop, M. R. (2009). Principles and overview of allogeneic hematopoietic stem cell transplantation. Cancer treatment and research, 144, 1–21. https://doi.org/10.1007/978-0-387-78580-6_1

Aladağ, E., Kelkitli, E., & Göker, H. (2020). Acute Graft-Versus-Host Disease: A Brief Review. Turkish journal of haematology : official journal of Turkish Society of Haematology, 37(1), 1–4. https://doi.org/10.4274/tjh.galenos.2019.2019.0157

Salmasian, H., Rohanizadegan, M., Banihosseini, S., Rahimi Darabad, R., Rabbani-Anari, M., Shakiba, A., & Ferrara, J. L. (2010). Corticosteroid regimens for treatment of acute and chronic graft versus host disease (GvHD) after allogenic stem cell transplantation. The Cochrane database of systematic reviews, 2010(1), CD005565. https://doi.org/10.1002/14651858.CD005565.pub2

Choe, H., & Ferrara, J. L. M. (2021). New therapeutic targets and biomarkers for acute graft-versus-host disease (GVHD). Expert opinion on therapeutic targets, 25(9), 761–771. https://doi.org/10.1080/14728222.2021.1992383

Buchman A. L. (2001). Side effects of corticosteroid therapy. Journal of clinical gastroenterology, 33(4), 289–294. https://doi.org/10.1097/00004836-200110000-00006

Van Assche, G., Vermeire, S., & Rutgeerts, P. (2008). Treatment of severe steroid refractory ulcerative colitis. World journal of gastroenterology, 14(36), 5508–5511. https://doi.org/10.3748/wjg.14.5508

Westin, J. R., Saliba, R. M., De Lima, M., Alousi, A., Hosing, C., Qazilbash, M. H., Khouri, I. F., Shpall, E. J., Anderlini, P., Rondon, G., Andersson, B. S., Champlin, R., & Couriel, D. R. (2011). Steroid-Refractory Acute GVHD: Predictors and Outcomes. Advances in hematology, 2011, 601953. https://doi.org/10.1155/2011/601953

Fabbri, M., Smart, C., & Pardi, R. (2003). T lymphocytes. The international journal of biochemistry & cell biology, 35(7), 1004–1008. https://doi.org/10.1016/s1357-2725(03)00037-2

Stem cell transplantation for acute lymphoblastic leukemia. Patient Care at NYU Langone Health. (n.d.). https://nyulangone.org/conditions/acute-lymphoblastic-leukemia/treatments/stem-cell-transplantation-for-acute-lymphoblastic-leukemia#:~:text=Allogeneic%20stem%20cell%20transplantation%20uses,people%20with%20acute%20lymphoblastic%20leukemia

Stem cell and bone marrow transplants. Hodgkin lymphoma | Cancer Research UK. (2020, October 6). https://www.cancerresearchuk.org/about-cancer/hodgkin-lymphoma/treatment/stem-cell-bone-marrow-transplants#:~:text=Stem%20cell%20or%20bone%20marrow,of%20cancer%2C%20including%20Hodgkin%20lymphoma

Jiang, H., Fu, D., Bidgoli, A., & Paczesny, S. (2021). T Cell Subsets in Graft Versus Host Disease and Graft Versus Tumor. Frontiers in immunology, 12, 761448. https://doi.org/10.3389/fimmu.2021.761448

Jacobsohn, D. A., & Vogelsang, G. B. (2007). Acute graft versus host disease. Orphanet journal of rare diseases, 2, 35. https://doi.org/10.1186/1750-1172-2-35

Flowers, M. E., Kansu, E., & Sullivan, K. M. (1999). Pathophysiology and treatment of graft-versus-host disease. Hematology/oncology clinics of North America, 13(5), 1091–ix. https://doi.org/10.1016/s0889-8588(05)70111-8

Ferrara, J. L., & Reddy, P. (2006). Pathophysiology of graft-versus-host disease. Seminars in hematology, 43(1), 3–10. https://doi.org/10.1053/j.seminhematol.2005.09.001

Getting a stem cell or bone marrow transplant. American Cancer Society. (n.d.). https://www.cancer.org/cancer/managing-cancer/treatment-types/stem-cell-transplant/process.html#:~:text=Conditioning%20treatment%20(chemo%20and%2For%20radiation%20therapy),-Conditioning%2C%20also%20known&text=It%27s%20done%20for%20one%20or,cells%20in%20the%20patient%27s%20body

Mayo Foundation for Medical Education and Research. (2022, July 20). Bone Marrow transplant. Mayo Clinic. https://www.mayoclinic.org/tests-procedures/allogeneic-stem-cell-transplant/pyc-20384863#:~:text=Stem%20cells%20from%20a%20donor%20will%20be%20infused%20into%20your,carefully%20for%20signs%20of%20complications

Khandelwal, P., Emoto, C., Fukuda, T., Vinks, A. A., Neumeier, L., Dandoy, C. E., El-Bietar, J., Chandra, S., Davies, S. M., Bleesing, J. J., Jordan, M. B., Mehta, P. A., Jodele, S., Grimley, M. S., Kumar, A., Myers, K. C., & Marsh, R. A. (2016). A Prospective Study of Alemtuzumab as a Second-Line Agent for Steroid-Refractory Acute Graft-versus-Host Disease in Pediatric and Young Adult Allogeneic Hematopoietic Stem Cell Transplantation. Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation, 22(12), 2220–2225. https://doi.org/10.1016/j.bbmt.2016.09.016

Ragon, B. K., Mehta, R. S., Gulbis, A. M., Saliba, R. M., Chen, J., Rondon, G., Popat, U. R., Nieto, Y., Oran, B., Olson, A. L., Patel, K., Hosing, C. M., Qazilbash, M. H., Shah, N., Kebriaei, P., Shpall, E. J., Champlin, R. E., & Alousi, A. M. (2018). Pentostatin therapy for steroid-refractory acute graft versus host disease: identifying those who may benefit. Bone marrow transplantation, 53(3), 315–325. https://doi.org/10.1038/s41409-017-0034-z

Ross, S. H., & Cantrell, D. A. (2018). Signaling and Function of Interleukin-2 in T Lymphocytes. Annual review of immunology, 36, 411–433. https://doi.org/10.1146/annurev-immunol-042617-053352

Liu, J., Fan, Z., Xu, N., Ye, J., Chen, Y., Shao, R., Sun, Y., Wu, Q., Liu, Q., & Jin, H. (2023). Ruxolitinib versus basiliximab for steroid-refractory acute graft-versus-host disease: a retrospective study. Annals of hematology, 10.1007/s00277-023-05361-9. Advance online publication. https://doi.org/10.1007/s00277-023-05361-9

Socié, G., Vigouroux, S., Yakoub-Agha, I., Bay, J. O., Fürst, S., Bilger, K., Suarez, F., Michallet, M., Bron, D., Gard, P., Medeghri, Z., Lehert, P., Lai, C., Corn, T., & Vernant, J. P. (2017). A phase 3 randomized trial comparing inolimomab vs usual care in steroid-resistant acute GVHD. Blood, 129(5), 643–649. https://doi.org/10.1182/blood-2016-09-738625

Tao, T., Ma, X., Yang, J., Zou, J. Y., Ji, S. M., Tan, Y. S., Gong, W., Du, F., Xu, J., Ye, C. M., Tang, X. W., Wu, D. P., & Xue, S. L. (2015). Humanized anti-CD25 monoclonal antibody treatment of steroid-refractory acute graft-versus-host disease: a Chinese single-center experience in a group of 64 patients. Blood cancer journal, 5(4), e308. https://doi.org/10.1038/bcj.2015.33

Ganetsky, A.; Frey, N. V.; Hexner, E. O.; Loren, A. W.; Gill, S. I.; Luger, S. M.; Mangan, J. K.; Martin, M. E.; Babushok, D. V.; Drobyski, W. R.; Smith, J.; Timlin, C.; Freyer, C. W.; Stadtmauer, E. A.; Porter, D. L. Tocilizumab for the Treatment of Severe Steroid-Refractory Acute Graft-Versus-Host Disease of the Lower Gastrointestinal Tract. Bone Marrow Transplantation 2018, 54 (2), 212–217. https://doi.org/10.1038/s41409-018-0236-z.

Huang, M., Ji, Y., Itahana, K., Zhang, Y., & Mitchell, B. (2008). Guanine nucleotide depletion inhibits pre-ribosomal RNA synthesis and causes nucleolar disruption. Leukemia research, 32(1), 131–141. https://doi.org/10.1016/j.leukres.2007.03.025

Rashidi, A., DeFor, T. E., Holtan, S. G., Blazar, B. R., Weisdorf, D. J., & MacMillan, M. L. (2019). Outcomes and Predictors of Response in Steroid-Refractory Acute Graft-versus-Host Disease. Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation, 25(11), 2297–2302. https://doi.org/10.1016/j.bbmt.2019.07.017

Haddad, R., & Saldanha-Araujo, F. (2014). Mechanisms of T-cell immunosuppression by mesenchymal stromal cells: what do we know so far?. BioMed research international, 2014, 216806. https://doi.org/10.1155/2014/216806

Oosten, L., van Pel, M., van der Holt, B., Bach, E., Cross, M., Roelofs, H., Meij, P., Wieles, B., Zwaginga, J. J., Lankester, A., Veelken, H., Platzbecker, U., Sanchez-Guijo, F., Algeri, M., Locatelli, F., Devos, T., Cornelissen, J., Niederwieser, D., & Fibbe, W. (2022). P1361: TREATMENT OF SEVERE STEROID-REFRACTORY ACUTE GVHD WITH MESENCHYMAL STROMAL CELLS: RESULTS OF THE PHASE III RANDOMIZED DOUBLE-BLIND MULTI-CENTER HOVON-113 TRIAL. HemaSphere, 6(Suppl ), 1245-1246. https://doi.org/10.1097/01.HS9.0000848304.76865.3a

Biddle, K. and Ahmed, S.H. (2019), Tacrolimus. Pract Diab, 36: 33-35. https://doi.org/10.1002/pdi.2209

Xhaard, A., Launay, M., Sicre de Fontbrune, F., Michonneau, D., Sutra Del Galy, A., Coman, T., Pagliuca, S., Dhedin, N., Robin, M., Peffault de Latour, R., & Socie, G. (2020). A monocentric study of steroid-refractory acute graft-versus-host disease treatment with tacrolimus and mTOR inhibitor. Bone marrow transplantation, 55(1), 86–92. https://doi.org/10.1038/s41409-019-0633-y

Levine J. E. (2011). Implications of TNF-α in the pathogenesis and management of GVHD. International journal of hematology, 93(5), 571–577. https://doi.org/10.1007/s12185-011-0803-1

Faraci, M., Calevo, M. G., Giardino, S., Leoni, M., Ricci, E., Castagnola, E., & Lanino, E. (2019). Etanercept as Treatment of Steroid-Refractory Acute Graft-versus-Host Disease in Pediatric Patients. Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation, 25(4), 743–748. https://doi.org/10.1016/j.bbmt.2018.11.017

Agrawal, V., Griffin, S. P., Koch, L., Thakrar, T. C., Ervin, K. D., Schmidt, C. A., ... & Zaid, M. A. (2019). Outcomes of Infliximab in Management of Steroid-Refractory Acute Graft Versus Host Disease. Biology of Blood and Marrow Transplantation, 25(3), S249-S250. https://doi.org/10.1016/j.bbmt.2018.12.250

Liu, Y., Zhang, D. T., & Liu, X. G. (2015). mTOR signaling in T cell immunity and autoimmunity. International reviews of immunology, 34(1), 50–66. https://doi.org/10.3109/08830185.2014.933957

Seif, F., Khoshmirsafa, M., Aazami, H., Mohsenzadegan, M., Sedighi, G., & Bahar, M. (2017). The role of JAK-STAT signaling pathway and its regulators in the fate of T helper cells. Cell communication and signaling : CCS, 15(1), 23. https://doi.org/10.1186/s12964-017-0177-y

Pidala, J., Hamadani, M., Dawson, P., Martens, M., Alousi, A. M., Jagasia, M., Efebera, Y. A., Chhabra, S., Pusic, I., Holtan, S. G., Ferrara, J. L. M., Levine, J. E., Mielcarek, M., Anasetti, C., Antin, J. H., Bolaños-Meade, J., Howard, A., Logan, B. R., Leifer, E. S., Pritchard, T. S., … MacMillan, M. L. (2020). Randomized multicenter trial of sirolimus vs prednisone as initial therapy for standard-risk acute GVHD: the BMT CTN 1501 trial. Blood, 135(2), 97–107. https://doi.org/10.1182/blood.2019003125

Chao, Y. H., Chang, Y. C., Wu, H. P., Peng, C. T., Weng, T. F., & Wu, K. H. (2017). Everolimus for pediatric patients with acute graft-versus-host disease after hematopoietic stem cell transplantation: A pilot study. Medicine, 96(44), e8464. https://doi.org/10.1097/MD.0000000000008464

Duensing, T. D., & Watson, S. R. (2018). Complement-Dependent Cytotoxicity Assay. Cold Spring Harbor protocols, 2018(2), 10.1101/pdb.prot093799. https://doi.org/10.1101/pdb.prot093799

1. Kasarello, K.; Mirowska-Guzel, D. Anti-CD52 Therapy for Multiple Sclerosis: An Update in the COVID Era. ImmunoTargets and Therapy 2021, Volume 10, 237–246. https://doi.org/10.2147/itt.s240890.

The Human Metabolome Database. (n.d.). Showing metabocard for deoxyadenosine (HMDB0000101). Human Metabolome Database: Showing metabocard for Deoxyadenosine (HMDB0000101). https://hmdb.ca/metabolites/HMDB0000101

Genini, D., Adachi, S., Chao, Q., Rose, D. W., Carrera, C. J., Cottam, H. B., Carson, D. A., & Leoni, L. M. (2000). Deoxyadenosine analogs induce programmed cell death in chronic lymphocytic leukemia cells by damaging the DNA and by directly affecting the mitochondria. Blood, 96(10), 3537–3543. https://doi.org/10.1182/blood.V96.10.3537

Fløisand, Y., Lundin, K. E. A., Lazarevic, V., Kristiansen, J. D., Osnes, L. T. N., Tjønnfjord, G. E., Reims, H. M., & Gedde-Dahl, T. (2017). Targeting Integrin α4β7 in Steroid-Refractory Intestinal Graft-versus-Host Disease. Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation, 23(1), 172–175. https://doi.org/10.1016/j.bbmt.2016.10.009

Picker, L. J., & Butcher, E. C. (1992). Physiological and molecular mechanisms of lymphocyte homing. Annual review of immunology, 10, 561–591. https://doi.org/10.1146/annurev.iy.10.040192.003021

Mehta, R. S., Saliba, R. M., Jan, A., Shigle, T. L., Wang, E., Nieto, Y., Ciurea, S. O., Oran, B., Im, J., Olson, A., Marin, D., Qazilbash, M., Khouri, I., Rondon, G., Anderlini, P., Rezvani, K., Popat, U., Kebriaei, P., Shpall, E., Champlin, R., … Alousi, A. (2021). Vedolizumab for Steroid Refractory Lower Gastrointestinal Tract Graft-Versus-Host Disease. Transplantation and cellular therapy, 27(3), 272.e1–272.e5. https://doi.org/10.1016/j.jtct.2020.12.011

Hart, J. W., Shiue, L. H., Shpall, E. J., & Alousi, A. M. (2013). Extracorporeal photopheresis in the treatment of graft-versus-host disease: evidence and opinion. Therapeutic advances in hematology, 4(5), 320–334. https://doi.org/10.1177/2040620713490316

Solh, M. M., Farnham, C., Solomon, S. R., Bashey, A., Morris, L. E., Holland, H. K., & Zhang, X. (2023). Extracorporeal photopheresis (ECP) improves overall survival in the treatment of steroid refractory acute graft-versus-host disease (SR aGvHD). Bone Marrow Transplantation, 58(2), 168-174. https://doi.org/10.1038/s41409-022-01860-x

https://www.cdc.gov/cdiff/what-is.html

Biliński, J., Jasiński, M., & Basak, G. W. (2022). The Role of Fecal Microbiota Transplantation in the Treatment of Acute Graft-versus-Host Disease. Biomedicines, 10(4), 837. https://doi.org/10.3390/biomedicines10040837

Malard, F., Loschi, M., Huynh, A., Cluzeau, T., Guenounou, S., Legrand, F., Magro, L., Orvain, C., Charbonnier, A., Panz-Klapuch, M., Desmier, D., Mear, J. B., Cornillon, J., Robin, C., Daguindau, E., Bilger, K., Vehreschild, M. J. G. T., Chevallier, P., Labussière-Wallet, H., Mediavilla, C., … Mohty, M. (2023). Pooled allogeneic faecal microbiota MaaT013 for steroid-resistant gastrointestinal acute graft-versus-host disease: a single-arm, multicentre phase 2 trial. EClinicalMedicine, 62, 102111. https://doi.org/10.1016/j.eclinm.2023.102111

MaaT Pharma. (2023, January 24). Pipeline. MaaT Pharma. https://www.maatpharma.com/pipeline/#maat013

Mount Sinai Health System. (n.d.). Fecal microbiota transplant. Mount Sinai Health System. https://www.mountsinai.org/health-library/surgery/fecal-microbiota-transplant#:~:text=FMT%20involves%20collecting%20stool%20from,previous%202%20to%203%20days

April 24, 2023: MaaT Pharma announces U.S. FDA Lifts Clinical Hold on Phase 3 Investigational New Drug Application for MAAT013 in patients with acute graft-versus-host disease. MaaT Pharma. (2023a, April 24). https://www.maatpharma.com/april-24-2023-maat-pharma-announces-u-s-fda-lifts-clinical-hold-on-phase-3-investigational-new-drug-application-for-maat013-in-patients-with-acute-graft-versus-host-disease/

He, Y., Sun, M. M., Zhang, G. G., Yang, J., Chen, K. S., Xu, W. W., & Li, B. (2021). Targeting PI3K/Akt signal transduction for cancer therapy. Signal transduction and targeted therapy, 6(1), 425. https://doi.org/10.1038/s41392-021-00828-5

Chi H. (2012). Regulation and function of mTOR signalling in T cell fate decisions. Nature reviews. Immunology, 12(5), 325–338. https://doi.org/10.1038/nri3198

Herrero-Sánchez, M. C., Rodríguez-Serrano, C., Almeida, J., San Segundo, L., Inogés, S., Santos-Briz, Á., García-Briñón, J., Corchete, L. A., San Miguel, J. F., Del Cañizo, C., & Blanco, B. (2016). Targeting of PI3K/AKT/mTOR pathway to inhibit T cell activation and prevent graft-versus-host disease development. Journal of hematology & oncology, 9(1), 113. https://doi.org/10.1186/s13045-016-0343-5

Muñoz-Fernández, R., De La Mata, C., Requena, F., Martín, F., Fernandez-Rubio, P., Llorca, T., Ruiz-Magaña, M. J., Ruiz-Ruiz, C., & Olivares, E. G. (2019). Human predecidual stromal cells are mesenchymal stromal/stem cells and have a therapeutic effect in an immune-based mouse model of recurrent spontaneous abortion. Stem cell research & therapy, 10(1), 177. https://doi.org/10.1186/s13287-019-1284-z

Jarzembowski, J. A. (2014). Normal structure and function of the placenta. Pathobiology of Human Disease, 2308–2321. https://doi.org/10.1016/b978-0-12-386456-7.05001-2

Ringden, O., Baygan, A., Remberger, M., Gustafsson, B., Winiarski, J., Khoein, B., Moll, G., Klingspor, L., Westgren, M., & Sadeghi, B. (2018). Placenta-Derived Decidua Stromal Cells for Treatment of Severe Acute Graft-Versus-Host Disease. Stem cells translational medicine, 7(4), 325–331. https://doi.org/10.1002/sctm.17-0167

Blazar, B. R., O’Connor, R. S., Milone, M. C., Dustin, M. L., Riley, J. L., Vincent, B. G., Serody, J. S., Flynn, R. P., Paz, K., Du, J., Panoskaltsis-Mortari, A., Jeffrey, M., Ahmed, R., Turka, L. A., Freeman, G. J., Sharpe, A. H., & Saha, A. (2015). Role of PD-1/PD-L1 in acute and chronic graft versus host disease. Blood, 126(23). https://doi.org/10.1182/blood.v126.23.sci-8.sci-8

Ding, D. C., Shyu, W. C., & Lin, S. Z. (2011). Mesenchymal stem cells. Cell transplantation, 20(1), 5–14. https://doi.org/10.3727/096368910X

Ding, Y., Liu, C., Cai, Y., Hou, C., Chen, G., Xu, Y., Hu, S., & Wu, D. (2023). The efficiency of human umbilical cord mesenchymal stem cells as a salvage treatment for steroid-refractory acute graft-versus-host disease. Clinical and experimental medicine, 10.1007/s10238-022-00983-1. Advance online publication. https://doi.org/10.1007/s10238-022-00983-1

Donadel, C. D., Pires, B. G., André, N. C., Costa, T. C. M., Orellana, M. D., Caruso, S. R., Seber, A., Ginani, V. C., Gomes, A. A., Novis, Y., Barros, G. M. N., Vilella, N. C., Martinho, G. H., Vieira, A. K., Kondo, A. T., Hamerschlak, N., Filho, J. S., Xavier, E. M., Fernandes, J. F., Rocha, V., … De Santis, G. C. (2023). Umbilical Cord Mesenchymal Stromal Cells for Steroid-Refractory Acute Graft-versus-Host Disease. Pharmaceuticals (Basel, Switzerland), 16(4), 512. https://doi.org/10.3390/ph16040512

Eliasson, J., Hvistendahl, M. K., Freund, N., Bolognani, F., Meyer, C., & Jeppesen, P. B. (2022). Apraglutide, a novel glucagon-like peptide-2 analog, improves fluid absorption in patients with short bowel syndrome intestinal failure: Findings from a placebo-controlled, randomized phase 2 trial. JPEN. Journal of parenteral and enteral nutrition, 46(4), 896–904. https://doi.org/10.1002/jpen.2223

Drucker D. J. (2001). Glucagon-like peptide 2. The Journal of clinical endocrinology and metabolism, 86(4), 1759–1764. https://doi.org/10.1210/jcem.86.4.7386

Kasikis, S., Etra, A., & Levine, J. E. (2021). Current and Emerging Targeted Therapies for Acute Graft-Versus-Host Disease. BioDrugs : clinical immunotherapeutics, biopharmaceuticals and gene therapy, 35(1), 19–33. https://doi.org/10.1007/s40259-020-00454-7

Abedin, S., & Hamadani, M. (2020). Experimental Pharmaceuticals for Steroid-Refractory Acute Graft-versus-Host Disease. Journal of experimental pharmacology, 12, 549–557. https://doi.org/10.2147/JEP.S259290

Tan, Y., Xiao, H., Wu, D., Luo, Y., Lan, J., Liu, Q., Yu, K., Shi, J., He, J., Zheng, W., Lai, X., Zhu, Y., Du, K., Ye, Y., Zhao, Y., Zheng, G., Hu, Y., Han, X., Zheng, Y., Wei, G., … Huang, H. (2017). Combining therapeutic antibodies using basiliximab and etanercept for severe steroid-refractory acute graft-versus-host disease: A multi-center prospective study. Oncoimmunology, 6(3), e1277307. https://doi.org/10.1080/2162402X.2016.1277307

Hess D. R. (2004). Retrospective studies and chart reviews. Respiratory care, 49(10), 1171–1174.

Published

05-31-2024

How to Cite

Nguyen, N. A., & McGeary, M. (2024). Current and Recent Advances in the Treatment of Steroid Refractory Acute Graft versus Host Disease . Journal of Student Research, 13(2). https://doi.org/10.47611/jsrhs.v13i2.6571

Issue

Section

HS Review Articles