Korean J Intern Med.  2014 Sep;29(5):630-636. 10.3904/kjim.2014.29.5.630.

Etanercept for steroid-refractory acute graft versus host disease following allogeneic hematopoietic stem cell transplantation

• Park JH
• Lee HJ
• Kim SR
• Song GW
• Lee SK
• Park SY
• Kim KC
• Hwang SH
• Park JS

• KMID: 1794628
• DOI: http://doi.org/10.3904/kjim.2014.29.5.630

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-refractory acute 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 4 weeks. The clinical responses were evaluated with regard to the severity of acute GVHD.
RESULTS
The median patient age was 43.5 years. Using nonparametric tests, etanercept had a down-grading effect on acute GVHD (p = 0.005), although no patient experienced complete remission. Partial responses were seen in 80%, 17%, and 57% of grade II to IV patients, respectively. Skin and gut GVHD were well controlled with etanercept, 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 after allo-SCT, with tolerable side effects.

Keyword

Stem cell transplantation; Graft vs host disease; TNFR-Fc fusion protein

MeSH Terms

Acute Disease
Adult
Aged
Allografts
Female
Graft vs Host Disease/etiology/*therapy
Hematopoietic Stem Cell Transplantation/*adverse effects
Humans
Immunoglobulin G/adverse effects/*therapeutic use
Immunosuppressive Agents/adverse effects/therapeutic use
Male
Middle Aged
Receptors, Tumor Necrosis Factor/*therapeutic use
Retrospective Studies
Steroids/therapeutic use
Young Adult
Immunoglobulin G
Immunosuppressive Agents
Receptors, Tumor Necrosis Factor
Steroids