Anti-tumor necrosis factor-a for the treatment of steroid-refractory acute graft-versus-host disease
Braz. j. med. biol. res
;
40(12): 1623-1629, Dec. 2007. tab
Article
Dans Anglais
| LILACS
| ID: lil-466736
ABSTRACT
Allogeneic stem cell transplantation has been increasingly performed for a variety of hematologic diseases. Clinically significant acute graft-versus-host disease (GVHD) occurs in 9 to 50 percent of patients who receive allogeneic grafts, resulting in high morbidity and mortality. There is no standard therapy for patients with acute GVHD who do not respond to steroids. Studies have shown a possible benefit of anti-TNF-a (infliximab)for the treatment of acute GVHD. We report here on the outcomes of 10 recipients of related or unrelated stem cell transplants who received 10 mg/kg infliximab, iv, once weekly for a median of 3.5 doses (range 1-6) for the treatment of severe acute GVHD and who were not responsive to standard therapy. All patients had acute GVHD grades II to IV (II = 2, III = 3, IV = 5). Overall, 9 patients responded and 1 patient had progressive disease. Among the responders, 3 had complete responses and 6 partial responses. All patients with cutaneous or gastrointestinal involvement responded, while only 2 of 6 patients with liver disease showed any response. None of the 10 patients had any kind of immediate toxicity. Four patients died, all of them with sepsis. Six patients are still alive after a median follow-up time of 544 days (92-600) after transplantation. Considering the severity of the cases and the bad prognosis associated with advanced acute GVHD, we find our results encouraging. Anti-TNF-a seems to be a useful agent for the treatment of acute GVHD.
Texte intégral:
Disponible
Indice:
LILAS (Amériques)
Sujet Principal:
Méthylprednisolone
/
Facteur de nécrose tumorale alpha
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Transplantation de cellules souches hématopoïétiques
/
Glucocorticoïdes
/
Maladie du greffon contre l'hôte
/
Anticorps monoclonaux
Type d'étude:
Étude observationnelle
/
Étude pronostique
/
Facteurs de risque
Limites du sujet:
Adolescent
/
Adulte
/
Enfant
/
Enfant d'âge préscolaire
/
Femelle
/
Humains
/
Mâle
langue:
Anglais
Texte intégral:
Braz. j. med. biol. res
Thème du journal:
Biologie
/
Médicament
Année:
2007
Type:
Article
Pays d'affiliation:
Brésil
Institution/Pays d'affiliation:
Instituto Nacional de Câncer/BR
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