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

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.