Etanercept for steroid-refractory acute graft versus host disease following allogeneic hematopoietic stem cell transplantation
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Background/Aims: The treatment for steroid-refractory acute graft versus host disease(GVHD) after allogeneic stem cell transplantation (allo-SCT) needs to be standardized. We report our clinical experience with etanercept for steroid-refractoryacute GVHD. Methods: Eighteen patients who underwent allo-SCT and presented with steroid-refractory acute GVHD at Ajou University Hospital were studied retrospectively. They were given 25 mg of etanercept subcutaneously twice weekly for 4weeks. The clinical responses were evaluated with regard to the severity of acuteGVHD. Results: The median patient age was 43.5 years. Using nonparametric tests, etanercepthad a down-grading effect on acute GVHD (p = 0.005), although no patient experiencedcomplete remission. Partial responses were seen in 80%, 17%, and 57% ofgrade II to IV patients, respectively. Skin and gut GVHD were well controlled withetanercept, whereas hepatic GVHD was not. Four patients died of fatal infections. No factors affecting the clinical outcome of etanercept were identified. Conclusions: Etanercept has a modest effect on steroid-refractory acute GVHD afterallo-SCT, with tolerable side effects.
Abstract
Background/Aims: The treatment for steroid-refractory acute graft versus host disease(GVHD) after allogeneic stem cell transplantation (allo-SCT) needs to be standardized. We report our clinical experience with etanercept for steroid-refractoryacute GVHD. Methods: Eighteen patients who underwent allo-SCT and presented with steroid-refractory acute GVHD at Ajou University Hospital were studied retrospectively. They were given 25 mg of etanercept subcutaneously twice weekly for 4weeks. The clinical responses were evaluated with regard to the severity of acuteGVHD. Results: The median patient age was 43.5 years. Using nonparametric tests, etanercepthad a down-grading effect on acute GVHD (p = 0.005), although no patient experiencedcomplete remission. Partial responses were seen in 80%, 17%, and 57% ofgrade II to IV patients, respectively. Skin and gut GVHD were well controlled withetanercept, whereas hepatic GVHD was not. Four patients died of fatal infections. No factors affecting the clinical outcome of etanercept were identified. Conclusions: Etanercept has a modest effect on steroid-refractory acute GVHD afterallo-SCT, with tolerable side effects.
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