Korean J Hematol.  2006 Mar;41(1):51-55. 10.5045/kjh.2006.41.1.51.

A Case of Steroid Refractory Acute GVHD Treated with IL-2 & TNF-alpha Blocker in a Myelodysplastic Syndrome Patient who Underwent Unrelated Allogeneic Stem Cell Transplantation

• Lee HH
• Ahn MJ
• Choi CU
• Park SR
• Baek YH
• Sohn W
• Lee DJ
• Chang MH
• Choi JH
• Lee YY
• Kim IS
• Park CK

• KMID: 2252328
• DOI: http://doi.org/10.5045/kjh.2006.41.1.51

Abstract

Hematopoietic stem cell transplantation has evolved as a central treatment modality for the management of various hematologic malignancies. Despite adequate posttransplantation immunosuppressive therapy, acute GVHD remains a major cause of morbidity and mortality, even for the patients who have received HLA identical sibling grafts. Once established, acute GVHD is difficult to treat, and the best primary treatments such as corticosteroid have shown responses of approximately 50%. Once GVHD becomes steroid-refractory, the chances of survival are slim at best, and the possibility of long-term complications from chronic GVHD is almost always the rule. Many agents are currently being evaluated to treat this malady, including ATG, monoclonal antibodies, pentostatin, denileukin diftitox, etc. We reported here on a case of steroid refractory acute GVHD that was treated with IL-2 and TNF-alpha blocker in myelodysplastic syndrome patient who underwent unrelated allogeneic stem cell transplantation.

Keyword

Hematopoietic stem cell transplantation; Steroid-refractory acute GVHD; IL-2 blocker; TNF-alpha blocker

MeSH Terms

Antibodies, Monoclonal
Hematologic Neoplasms
Hematopoietic Stem Cell Transplantation
Humans
Interleukin-2*
Mortality
Myelodysplastic Syndromes*
Pentostatin
Siblings
Stem Cell Transplantation*
Stem Cells*
Transplants
Tumor Necrosis Factor-alpha*
Antibodies, Monoclonal
Interleukin-2
Pentostatin
Tumor Necrosis Factor-alpha

Figure

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  Fig. 1 The time schedule of stem cell transplantation and engraftment.

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  Fig. 2 Acute GVHD involving whole area of skin. See the maculopapular rash on face A), both hands, foots B), and abdomen C).

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  Fig. 3 Biopsy of skin lesion (right wrist): The epidermis shows atrophy & basal vacuolization and opposition of lymphocytes to apoptotic keratinocytes. The dermis shows thickening of dermal collagen fibers which assume a parallel arrangement (H&E stain; × 50 objective).

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