Journal of geriatric oncology · 2026
Graft versus host disease treatment and prevention in older adults: A single-database review.
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Ciurylo William, Hamparsumian Anahid, Wall Sarah, Meyers Gabrielle
Аннотация
INTRODUCTION: Hematopoietic stem cell transplantation (SCT) is increasingly used to treat hematological conditions in patients 60 years and older. Graft vs host disease (GVHD), a complication of SCT, is a major cause of morbidity, nonrelapse mortality, and interference with quality of life (QOL). Concern that older adults are at higher risk for developing GVHD has limited the use of SCT in this population. Older adults are also at higher risk for adverse events from the mainstay treatment of GVHD: corticosteroids. There is no standard of care for the management of GVHD in older adults, which may limit older adults' access to SCT. We aimed to review the literature on non-corticosteroid immune modulating agents used to prevent and treat GVHD for outcomes data specific to older adults.
MATERIALS AND METHODS: We performed a scoping review using Pubmed, identifying 31 studies comparing immunosuppressive prophylaxis and treatment modalities for GVHD (acute, chronic, mixed, and corticosteroid refractory) within a 10-year span (February 13, 2013 - February 13, 2023). Articles exploring cutaneous GVHD only or corticosteroid treatments were excluded. Articles were reviewed for inclusion of patients 65+ years, response rate, mortality rate, adverse events, degree of corticosteroid sparing, and QOL scores before and after treatment.
RESULTS: Seventeen articles met inclusion criteria, for a total of 2534 patients with GVHD. Two articles did not include patients 65+, ten did not specify the number of patients 65+, and five articles indicated the number of patients 65+ (n = 160). No articles specified response rate, mortality rate, or adverse events in patients 65+. Twelve articles indicated degree of corticosteroid sparing. Six articles included QOL scores, but did not assess impact of treatment on QOL scores or specify QOL scores in patients 65+. Overall, 3.5% of study participants were identified as aged 65+ and 4.7% aged 60 + .
DISCUSSION: There is a lack of relevant outcomes data to guide best practice in the prevention and treatment of GVHD in older adults Understanding the risk of GVHD in older adults and identifying effective prophylactic and treatment strategies for GVHD in older adults may result in more older adults having access to SCT.
MATERIALS AND METHODS: We performed a scoping review using Pubmed, identifying 31 studies comparing immunosuppressive prophylaxis and treatment modalities for GVHD (acute, chronic, mixed, and corticosteroid refractory) within a 10-year span (February 13, 2013 - February 13, 2023). Articles exploring cutaneous GVHD only or corticosteroid treatments were excluded. Articles were reviewed for inclusion of patients 65+ years, response rate, mortality rate, adverse events, degree of corticosteroid sparing, and QOL scores before and after treatment.
RESULTS: Seventeen articles met inclusion criteria, for a total of 2534 patients with GVHD. Two articles did not include patients 65+, ten did not specify the number of patients 65+, and five articles indicated the number of patients 65+ (n = 160). No articles specified response rate, mortality rate, or adverse events in patients 65+. Twelve articles indicated degree of corticosteroid sparing. Six articles included QOL scores, but did not assess impact of treatment on QOL scores or specify QOL scores in patients 65+. Overall, 3.5% of study participants were identified as aged 65+ and 4.7% aged 60 + .
DISCUSSION: There is a lack of relevant outcomes data to guide best practice in the prevention and treatment of GVHD in older adults Understanding the risk of GVHD in older adults and identifying effective prophylactic and treatment strategies for GVHD in older adults may result in more older adults having access to SCT.