The Outcome In Patients Receiving Imatinib For Steroid-refractory Chronic GVHD After Allogeneic Stem Cell Transplantation

Objective:To investigate the clinical characteristics,related risk factors and therapeutic effects of extensive chronic graft-versus-host disease after allogeneic hematopoietic stem cell transplantation and the efficacy and safety of imatinib in the treatment of steroid refractory chronic graft-versus-host disease.Method:We performed a retrospective analysis of all the 264 patients who received allogeneic hematopoietic stem cell transplantation from June 2012 to June 2015 in Bone Marrow Transplantation Center of the First Affiliated Hospital of Zhejiang University.Describe the 14 patients’ clinical characteristics of whom happened to steroid-refractory chronic graft-versus-host disease,involving skin,lungs,eyes,mouth.liver and gastrointestinal tract.Patients diagnosed as chronic graft-versus-host disease with lung or skin involvement were advised to use imatinib 300mg/d as a second-line therapy.Result:All 14 patients occurred as chronic GVHD at a median time of 9.5 months(range,4-14)after transplantation.They had active chronic GVHD with measurable involvement of skin,lung or other districts and had previously failed in first-line immunosuppressive therapy.The major organs involved were lung(n=9),skin(n=10),eyes(n=7),mouth(n=6),joint(n=3),liver(n=1).Patients defined as steroid-refractory cGVHD were treated by Imatinib,acquiring a 64.3%stable response in 3 months,and nobody had complete remission yet.Andthe ORR rose to 75.0%in 6 months,with the CR rate about 16.7%.Of the whole organs,skins,lungs,eyes,mouths,joints.and liver had the ORR of 50.0%、71.4%、100%、85.7%、100%、100%,respectively.And the CR rates were up to 25.0%、14.3%、60.0%、71.4%、100%、100%,respectively.At a median follow-up time of 33 months,about 50%of patients reduced the maintenance dose of immunosuppressive therapy,moreover,1 patient completely withdrawal.No serious imatinib-related adverse events occurred in our study.Conclusion:This study suggests that imatinib is a promising and safe treatment for patients with steroid refractory chronic graft-versus-host disease.Longer follow up to determine the durability of response and survival is required.