Etanercept as Treatment of Steroid-Refractory Acute Graft-versus-Host Disease in Pediatric Patients.

Biol Blood Marrow Transplant 2019 04 22;25(4):743-748. Epub 2018 Nov 22.

Hematopoietic Stem Cell Transplant Unit, Giannina Gaslini Institute, Scientific Institute for Research, Hospitalization and Healthcare, Genoa, Italy.

Corticosteroids are the standard of care for first-line treatment of patients who develop grade II-IV of acute graft-versus-host disease (aGVHD), but the optimal second-line treatment has not yet been determined. We prospectively evaluated the use of the anti-TNFα monoclonal antibody etanercept (ET) as second-line treatment in children with steroid-refractory (SR) aGVHD. Twenty-five children with either malignant or nonmalignant diseases experiencing grade II-IV SR aGVHD received ET as second-line treatment. ET was administered after a median of 14days (range, 5 to 135 days) from the onset of aGVHD. Seventeen out of 25 patients (68%) developed a complete response (CR) or partial response (PR) to ET. The overall response rate (CR plus PR) was 78% in patients with cutaneous SR aGVHD, 78% in those with gastrointestinal aGVHD, and 57% in those with hepatic aGVHD. On day +100 after the start of ET, 52% of the children were in CR, 16% were in PR, and the remaining 32% failed to respond. Overall survival was 76.5% in responders and 16.7% in nonresponders (P = .004). Transplantation-related mortality at 5years was 34.1% (95% confidence interval, 18.6% to 57.1%). In our experience, ET has proven to be effective as second-line treatment in children with SR aGVHD.

Download full-text PDF

Source
https://linkinghub.elsevier.com/retrieve/pii/S10838791183075
Publisher Site
http://dx.doi.org/10.1016/j.bbmt.2018.11.017DOI Listing
April 2019

Publication Analysis

Top Keywords

second-line treatment
16
treatment children
8
agvhd
8
graft-versus-host disease
8
acute graft-versus-host
8
grade ii-iv
8
treatment
5
median 14days
4
administered median
4
+100 start
4
transplantation-related mortality
4
range 135
4
day +100
4
days onset
4
135 days
4
p = 004 transplantation-related
4
mortality 5years
4
14days range
4
received second-line
4
341% 95%
4

Similar Publications