Adverse reactions of commonly used therapies in refractory chronic GVHD14
| Agent . | Potential major adverse effects (with major study citations) . | Common (>10%) generally less severe adverse effects . |
|---|---|---|
| Bortezomib | Peripheral neuropathy, thrombocytopenia, malignancy relapse106 | Herpes virus reactivation |
| ECP | Vascular access complications107 | Thrombocytopenia |
| FAM | New FDA MedWatch warning; warning only applies to azithromycin use in prophylactic (not treatment) setting108,109 | |
| Ibrutinib (Imbruvica R) | Pneumonia,29 impaired platelet function | Fatigue, muscle pain, peripheral edema |
| Imatinib | Peripheral edema | |
| Interleukin-2 | Injection site induration, infections36 | Constitutional flu-like symptoms |
| MMF (Cellcept) | Viral reactivation, hypertension, pneumonia, posttransplantation lymphoproliferative disease110 | GI toxicity, neutropenia, leukopenia |
| Pamolidomide | Tremor, muscle cramps, peripheral neuropathy111 | Skin rash |
| Rituximab (Rituxan R) | Infection, late neutropenia38,39,112 | B lymphopenia |
| Ruxolitinib (Jakafi R) | Viral reactivation/infection, bacterial infections35 | Cytopenias |
| Sirolimus (Rapamune) | TAM when used in combination with calcineurin inhibitors, renal insufficiency,113 proteinuria | Peripheral edema, hyperlipidemia, cytopenias |
| Agent . | Potential major adverse effects (with major study citations) . | Common (>10%) generally less severe adverse effects . |
|---|---|---|
| Bortezomib | Peripheral neuropathy, thrombocytopenia, malignancy relapse106 | Herpes virus reactivation |
| ECP | Vascular access complications107 | Thrombocytopenia |
| FAM | New FDA MedWatch warning; warning only applies to azithromycin use in prophylactic (not treatment) setting108,109 | |
| Ibrutinib (Imbruvica R) | Pneumonia,29 impaired platelet function | Fatigue, muscle pain, peripheral edema |
| Imatinib | Peripheral edema | |
| Interleukin-2 | Injection site induration, infections36 | Constitutional flu-like symptoms |
| MMF (Cellcept) | Viral reactivation, hypertension, pneumonia, posttransplantation lymphoproliferative disease110 | GI toxicity, neutropenia, leukopenia |
| Pamolidomide | Tremor, muscle cramps, peripheral neuropathy111 | Skin rash |
| Rituximab (Rituxan R) | Infection, late neutropenia38,39,112 | B lymphopenia |
| Ruxolitinib (Jakafi R) | Viral reactivation/infection, bacterial infections35 | Cytopenias |
| Sirolimus (Rapamune) | TAM when used in combination with calcineurin inhibitors, renal insufficiency,113 proteinuria | Peripheral edema, hyperlipidemia, cytopenias |
This list of agents represents a fraction of agents being actively evaluated. Preferred use of any agent still requires validation via larger clinical trials.
ECP, extracorporeal photopheresis; FAM, fluticasone, azithromycin, and montelukast; FDA, US Food and Drug Administration; GI, gastrointestinal; MMF, mycophenolate mofetil; TAM, transplantation-associated microangiopathy.