Etanercept plus methylprednisolone as initial therapy for acute graft-versus-host disease
Open Access
- 15 February 2008
- journal article
- Published by American Society of Hematology in Blood
- Vol. 111 (4), 2470-2475
- https://doi.org/10.1182/blood-2007-09-112987
Abstract
Graft-versus-host disease (GVHD) is a principal cause of morbidity following allogeneic hematopoietic cell transplantation (HCT). Standard therapy for GVHD, high-dose steroids, results in complete responses (CRs) in 35% of patients. Because tumor necrosis factor-α (TNFα) is an important effector of experimental GVHD, we treated patients with new-onset GVHD with steroids plus the TNFα inhibitor etanercept on a previously reported pilot trial (n = 20) and a phase 2 trial (n = 41). We compared their outcomes with those of contemporaneous patients with GVHD (n = 99) whose initial therapy was steroids alone. Groups were similar with respect to age, conditioning, donor, degree of HLA match, and severity of GVHD at onset. Patients treated with etanercept were more likely to achieve CR than were patients treated with steroids alone (69% vs 33%; P < .001). This difference was observed in HCT recipients of both related donors (79% vs 39%; P = .001) and unrelated donors (53% vs 26%; P < .001). Plasma TNFR1 levels, a biomarker for GVHD activity, were elevated at GVHD onset and decreased significantly only in patients with CR. We conclude that etanercept plus steroids as initial therapy for acute GVHD results in a substantial majority of CRs. This trial was referenced at www.clinicaltrials.gov as NCT00141713.Keywords
This publication has 32 references indexed in Scilit:
- Absence of donor T-cell–derived soluble TNF decreases graft-versus-host disease without impairing graft-versus-tumor activityBlood, 2007
- EtanerceptDrugs, 2007
- Recombinant human soluble tumor necrosis factor receptor fusion protein as treatment for steroid refractory graft‐versus‐host disease following allogeneic hematopoietic stem cell transplantationAmerican Journal of Hematology, 2006
- Prophylaxis and Treatment of Acute Graft-Versus-Host DiseaseSeminars in Hematology, 2006
- Pilot Trial on the Use of Etanercept and Methylprednisolone as Primary Treatment for Acute Graft-versus-Host DiseaseTransplantation and Cellular Therapy, 2005
- Serious Infections Associated with Anticytokine Therapies in the Rheumatic DiseasesJournal of Intensive Care Medicine, 2004
- Tumor necrosis factor-α blockade for the treatment of acute GVHDBlood, 2004
- Lowered-intensity preparative regimen for allogeneic stem cell transplantation delays acute graft-versus-host disease but does not improve outcome for advanced hematologic malignancyTransplantation and Cellular Therapy, 2003
- Lowered-intensity preparative regimen for allogeneic stem cell transplantation delays acute graft-versus-host disease but does not improve outcome for advanced hematologic malignancyTransplantation and Cellular Therapy, 2003
- Tumor necrosis factor/cachectin is an effector of skin and gut lesions of the acute phase of graft-vs.-host disease.The Journal of Experimental Medicine, 1987