Combination Daclizumab and Infliximab for Steroid Refractory Acute Graft-Versus-Host Disease.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 4643-4643
Author(s):  
Alison Rager ◽  
Steven C. Goldstein ◽  
Noelle Frey ◽  
Jennifer Davis ◽  
Michael Vozniak ◽  
...  
Keyword(s):  
Graft Versus Host Disease ◽  
Acute Gvhd ◽  
Myelogenous Leukemia ◽  
Cell Transplant ◽  
Cytokine Therapy ◽  
Host Disease ◽  
Graft Versus Host ◽  
Unrelated Donors ◽  
Steroid Refractory ◽  
Acute Graft

Abstract Abstract 4643 Systemic steroids are the mainstay of therapy for GVHD, but treatment failure is common. Inflammatory cytokines, including IL-2 and TNF-a, are important mediators of GVHD, and may be critical targets for therapy. Given the ineffective treatment options for patients (pts) with steroid-refractory GVHD (SR-GVHD) and the almost universally poor outcomes with available therapies, between June 2001-May 2008, we treated 22 patients with SR-GVHD with a combination of anti-cytokine therapy that included daclizumab and infliximab. Seventeen of these patients were evaluable for a retrospective review of detailed outcomes. The median age was 48 years (range 35-63) and grafts were from HLA matched siblings (5), matched unrelated donors (9), 1 antigen mismatched unrelated donors (2), or cord blood (1). Indications for stem cell transplant (SCT) were acute leukemia (9), chronic myelogenous leukemia (1), lymphoma (5) chronic lymphocytic leukemia (1) and multiple myeloma (1). Most patients received methotrexate with either tacrolimus (14) or cyclosporine (CSA) (2) and 1 patient received CSA with steroids as initial GVHD prophylaxis. High dose steroids were started for acute GVHD a median of 39 days after transplant in 12 pts (range 25-119). Five additional patients developed SR-GVHD a median of 46 days (range 25-119) after donor lymphocyte infusion. All patients had persistent or progressive acute GVHD despite 1mg/kg/day (4 pts) or 2 mg/kg/day (13 pts) of corticosteroids for a median of 8 days (range 5-26) and were treated for acute GVHD severity index B (3), C (10) or D (4). GVHD involved the skin in 9 pts, liver in 9 pts, and gut in 15 pts. Daclizumab was given at 1.5 mg/kg day 1 and 1 mg/kg day 4, 8, 15, and 22. Infliximab was given at 10 mg/kg day 1,8,15, and 22. Overall, 47% of patients responded to therapy. Four patients (24%) had complete resolution of symptoms and 4 (24%) had partial responses. The remaining 9 patients failed to respond, progressed or had a mixed response. Additional therapies were started in 7 patients. Similar to other available reports on SR-GVHD, survival was limited and all pts died at a median of 6.7 months (range 1.6-26) from transplant and 37 days from initiation of daclizumab/ infliximab (8 from infection, 5 from GVHD, 2 from relapsed disease, and 2 from other causes). Data from additional patients will be presented. Although this is a retrospective analysis, these results suggest that combination anti-cytokine therapy with daclizumab/infliximab has significant activity in SR-GVHD, but outcomes remain poor. New methods to prevent and treat GVHD are urgently needed. Disclosures: Off Label Use: Daclizumab and Infliximab were used to treat acute Graft versus Host Disease. Porter:Genentec: Spouse employed by Genentech, owned by Roche, manufacturer of daclizumab.

Improved Survival using Dual Monoclonal Antibody Therapy with Aggressive Anti-Microbial Prophylaxis In Steroid-Refractory Acute Graft-Versus-Host Disease

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 1262-1262
Author(s):  
Melissa Sanacore ◽  
Karen Manion ◽  
Pauline Smith ◽  
Xu Zhang ◽  
H. Kent Holland ◽  
...  
Keyword(s):  
Graft Versus Host Disease ◽  
Antibody Therapy ◽  
Myelogenous Leukemia ◽  
Host Disease ◽  
Graft Versus Host ◽  
Line Therapy ◽  
Unrelated Donors ◽  
Cmv Reactivation ◽  
Steroid Refractory ◽  
Acute Graft

Abstract Abstract 1262 Steroid-refractory acute graft versus host disease (aGVHD) is associated with a poor prognosis. Although clinical responses occur to second line therapy they are associated with high rates of infection and dismal long-term survival. Blockade at 2 different points in the cytokine cascade with infliximab and daclizumab (double antibody therapy, DAT), along with aggressive infection prophylaxis may improve outcomes. We retrospectively reviewed our experience using DAT in steroid-refractory aGVHD. Between December 2005 and December 2009, 22 patients were treated of which 20 are evaluable. All patients had persistent or progressive aGVHD despite 1–2 mg/kg/d steroids for a median of 9 days (range 2–55). Five patients had failed 2nd line systemic aGVHD therapy and 1 patient failed 3rd line therapy prior to DAT. Combination therapy was given for aGVHD grade 2 (n=3), 3 (n=13), or 4 (n=4). GVHD involved the skin in 7 patients, the liver in 9 patients and GI tract in 16 patients. The median age at time of therapy was 55 years (range 29–69). Grafts were from HLA identical siblings (9), 10 locus matched unrelated donors (5), 9/10 locus matched unrelated donors (3), cord blood (2) or 5/10 haploidentical donor (1). The conditioning regimen was myeloablative in 10 patients, and either nonmyeloablative or reduced intensity in 10 patients. Indications for stem cell transplant were acute leukemia (7), chronic myelogenous leukemia (2), chronic lymphocytic leukemia (1), myelodysplastic syndrome (4), non-Hodgkins lymphoma (5), and multiple myeloma (1). Most patients received methotrexate (MTX) with tacrolimus (FK)(14) or mycophenolate (MMF) (4) for GVHD prophylaxis; one patient received MTX with FK and MMF and one FK alone. Fifteen patients developed aGVHD after the primary transplant and five after donor lymphocyte infusion. Daclizumab was given (1mg/kg) day 1,4,8,15, and 22, and infliximab (10mg/kg) days 1,8,15, and 22. Steroid therapy was aggressively tapered upon commencement of DAT. Maximal response achieved by day 60 post initiation of therapy was assessed. Five pts (25%) attained a CR (resolution of all symptoms), 10 (50%) PR (improvement in ≥ 1 organ & no progression in others), 2(10%) MR (improvement in ≥ 1 organ & deterioration or new symptoms in others) and 3 (15%) no response. Five patients received 1–2 additional courses of DAT at a median of 60 days. Three patients (15%) were concurrently on an investigational protocol utilizing mesenchymal stem cells. All patients received antifungal (azole with mold coverage or echinocandin), anti-Herpes virus, and Pneumocystis prophylaxis. Patients with gastrointestinal GVHD also received antibacterial prophylaxis irrespective of neutropenia. Patients were monitored once or twice weekly for CMV reactivation and received preemptive therapy upon reactivation. Only two patients had documented fungal infections: Mucormycosis in 1 and Candida parapsilosis in 1. Sixteen (80%) of patients had bacterial infections, including 21 gram-positive infections and 13 gram-negative infections. Viral infections, primarily CMV reactivation, occurred in 16 patients (80%). As of August 2010, 12 patients have died after a median of 102 days from initiation of DAT (range 14–658) (5 from relapsed or progressive disease, 3 from aGVHD, 2 from cGVHD, and 2 from organ failure). With a median follow up of 511 days for living patients, the estimated probability of survival at 6 months and 12 months is 55% and 50%, respectively. DAT is an effective therapy for steroid-refractory aGVHD. Survival beyond 6 months can be achieved in approximately half the patients using this strategy. Aggressive antifungal and antiviral prophylaxis may have contributed to this outcome. Disclosures: Off Label Use: Infliximab and daclizumab are not FDA approved for GVHD.

Acute Graft Versus Host Disease after Donor Lymphocyte Infusion: A Single Center Analysis

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 5807-5807
Author(s):  
Fiona C. He ◽  
Daniel J. Weisdorf ◽  
Erica D. Warlick ◽  
Jeffrey S. Miller ◽  
Shernan G. Holtan ◽  
...  
Keyword(s):  
Graft Versus Host Disease ◽  
Acute Gvhd ◽  
Conflicts Of Interest ◽  
Significant Risk ◽  
Donor Lymphocyte Infusion ◽  
Myelogenous Leukemia ◽  
Host Disease ◽  
Graft Versus Host ◽  
Grade Ii ◽  
Acute Graft

Abstract Donor lymphocyte infusion (DLI) is an option for relapsed hematologic malignancies following allogeneic hematopoietic cell transplantation (HCT). We analyzed the incidence and manifestations of acute graft versus host disease (GVHD) in patients with malignant and non-malignant conditions treated with DLI. At the University of Minnesota, we gave 171 DLI to 120 patients from 1995-2013. The cumulative incidence of grade II-IV acute GVHD was 31.6% (CI 25-42%,n = 40); grade III-IV 23.3% (CI 16-32%,n = 29). GVHD after DLI (n = 46) included involvement of skin in 70% (n = 32), lower gastrointestinal (GI) 65% (n = 30), upper GI 43% (n = 20), and liver 35% (n = 16). Patients receiving chemotherapy prior to DLI (chemo-DLI) had more frequent acute GVHD and GI GVHD. Significant risk factors for grade II-IV acute GVHD included: age > 40, chemo-DLI, malignant disease, and time from HCT to DLI < 200 days. Response to treatment of acute GVHD at 8 weeks was complete in 40% and complete/partial in 52%. Patients developing GVHD had frequent disease response. In chronic myelogenous leukemia (CML) patients, responses were excellent (80%) with or without GVHD. The CR rate was 34% for non-CML malignancies; only 9% achieved CR without acute GVHD. Non-malignant diseases showed poor prognosis following acute GVHD and good prognosis without. Overall survival at 2 years for CML patients was similar (83% vs 79%, p = 0.89) with or without grade II-IV acute GVHD, but in non-CML malignancies survival was better in absence of acute GVHD (41% vs 22%, p = 0.04). We observed frequent, yet therapy-responsive acute GVHD following DLI. DLI often induced remission in CML, but less so for non-CML malignancies without chemo-DLI, particularly in absence of acute GVHD. Improvements in DLI efficacy and GVHD management are still needed. Disclosures No relevant conflicts of interest to declare.

Sirolimus Yields High Response Rates in Hematopoietic Allograft Recipients with Steroid-Refractory Acute Graft-Versus-Host Disease.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 2235-2235
Author(s):  
Joseph A. Pidala ◽  
Daanish Hoda ◽  
Norma Salgado-Vila ◽  
Jongphil Kim ◽  
Janelle Perkins ◽  
...  
Keyword(s):  
Graft Versus Host Disease ◽  
Immunosuppressive Agents ◽  
Cell Transplant ◽  
Hematopoietic Cell Transplant ◽  
Host Disease ◽  
Graft Versus Host ◽  
Allogeneic Hematopoietic Cell Transplant ◽  
Maximum Decrease ◽  
Steroid Refractory ◽  
Acute Graft

Abstract Abstract 2235 Poster Board II-212 Acute graft-versus-host disease (aGVHD) remains the major cause of morbidity and mortality in allogeneic hematopoietic cell transplant recipients. There is no consensus in regards to the best therapy for patients who fail to respond to, or do not tolerate, systemic glucocorticoids. We evaluate the efficacy of sirolimus in 34 pts, median age of 49 (23-67) years, with steroid-refractory (N=31) or steroid-intolerant (N=3) aGVHD. The diagnosis of aGVHD was established at a median of 34 (7-1042) days after transplantation, and confirmed by biopsy in all cases. Initial treatment of aGVHD consisted of prednisone up to 2 mg/kg. Sirolimus was initiated at a median of 9 (1-255) days after glucocorticoid initiation. A loading dose of sirolimus was administered to 19 (56%) of 34 pts, median 6 (3-8) mg, followed by maintenance therapy of 1-2 mg per day with doses adjusted to target therapeutic trough levels between 4 and 12 ng/ml; therapeutic levels were achieved in all cases. The overall response rate was 76%. Fifteen (44%) of the 34 pts achieved a CR after sirolimus initiation and without requiring additional immune suppressive agents. CR was achieved in 11/31 (42%) steroid-refractory patients, and in 2/3 (67%) steroid-intolerant patients. The median overall survival (OS) after initiation of sirolimus was 5.6 months, and one year OS was 44% (95% C.I. 27%-60%). Maximum decrease in dose of steroids over 12 weeks following sirolimus was a median of 50% (range 0-100%). Fourteen (42%) of 33 pts reached a dose < 20 mg of prednisone at a median of 4 months (95% CI: 3.5-13.5) after initiation of sirolimus. Seven (21%) of 34 pts were free from steroids after a median of 20 months (95% CI: 9.2-20.0) after initiation of sirolimus. Two pts were shown to be successfully liberated from all immunosuppressive agents without recurrent GVHD at 2.7 and 7.1 months after initiation of sirolimus, respectively. These data indicate the sirolimus is effective in controlling steroid-refractory aGVHD. Further studies are needed to determine the most appropriate timing for sirolimus after transplantation, whether prophylaxis, primary or secondary GVHD therapy. Disclosures: Off Label Use: Sirolimus for graft-versus-host disease.

scholarly journals Tacrolimus and minidose methotrexate for prevention of acute graft- versus-host disease after matched unrelated donor marrow transplantation

Blood ◽  
1996 ◽  
Vol 88 (11) ◽  
pp. 4383-4389 ◽  
Author(s):  
D Przepiorka ◽  
C Ippoliti ◽  
I Khouri ◽  
M Woo ◽  
R Mehra ◽  
...  
Keyword(s):  
Graft Versus Host Disease ◽  
Marrow Transplantation ◽  
Acute Gvhd ◽  
Advanced Disease ◽  
Unrelated Donor ◽  
Matched Unrelated Donor ◽  
Host Disease ◽  
Graft Versus Host ◽  
Unrelated Donors ◽  
Acute Graft

Abstract Thirty adults with leukemia or lymphoma undergoing marrow transplantation from HLA-compatible unrelated donors received tacrolimus (FK506), a new immunosuppressive macrolide lactone, and minidose methotrexate to prevent acute graft-versus-host disease (GVHD). The group had a median age of 36 years (range 21 to 49 years). Twenty-four patients had advanced disease, and 11 were resistant to conventional therapy. Tacrolimus was administered at 0.03 mg/kg/d intravenously (i.v.) by continuous infusion from day -2, converted to oral at four times the i.v. dose following engraftment, and continued through day 180 posttransplant. Methotrexate 5 mg/m2 was given i.v. on days 1, 3, 6, and 11. All patients engrafted. Grades 2–4 GVHD occurred in 34% (95% CI, 17% to 52%), and grades 3–4 GVHD in 17% (95% CI, 3% to 31%). Mild renal toxicity was common before day 100; 63% of patients had a doubling of creatinine, and 52% had a peak creatinine greater than 2 mg/dL, but only one patient was dialyzed. The median last i.v. dose of tacrolimus was 53% of the scheduled dose, and the median oral dose on day 100 was 41% of that scheduled. Overall survival at 1 year was 47% (95% CI, 27% to 66%). We conclude that tacrolimus can be combined safely with minidose methotrexate, and the combination has substantial activity in preventing acute GVHD after unrelated donor marrow transplantation.

scholarly journals Tacrolimus and minidose methotrexate for prevention of acute graft- versus-host disease after matched unrelated donor marrow transplantation

Blood ◽  
1996 ◽  
Vol 88 (11) ◽  
pp. 4383-4389 ◽  
Author(s):  
D Przepiorka ◽  
C Ippoliti ◽  
I Khouri ◽  
M Woo ◽  
R Mehra ◽  
...  
Keyword(s):  
Graft Versus Host Disease ◽  
Marrow Transplantation ◽  
Acute Gvhd ◽  
Advanced Disease ◽  
Unrelated Donor ◽  
Matched Unrelated Donor ◽  
Host Disease ◽  
Graft Versus Host ◽  
Unrelated Donors ◽  
Acute Graft

Thirty adults with leukemia or lymphoma undergoing marrow transplantation from HLA-compatible unrelated donors received tacrolimus (FK506), a new immunosuppressive macrolide lactone, and minidose methotrexate to prevent acute graft-versus-host disease (GVHD). The group had a median age of 36 years (range 21 to 49 years). Twenty-four patients had advanced disease, and 11 were resistant to conventional therapy. Tacrolimus was administered at 0.03 mg/kg/d intravenously (i.v.) by continuous infusion from day -2, converted to oral at four times the i.v. dose following engraftment, and continued through day 180 posttransplant. Methotrexate 5 mg/m2 was given i.v. on days 1, 3, 6, and 11. All patients engrafted. Grades 2–4 GVHD occurred in 34% (95% CI, 17% to 52%), and grades 3–4 GVHD in 17% (95% CI, 3% to 31%). Mild renal toxicity was common before day 100; 63% of patients had a doubling of creatinine, and 52% had a peak creatinine greater than 2 mg/dL, but only one patient was dialyzed. The median last i.v. dose of tacrolimus was 53% of the scheduled dose, and the median oral dose on day 100 was 41% of that scheduled. Overall survival at 1 year was 47% (95% CI, 27% to 66%). We conclude that tacrolimus can be combined safely with minidose methotrexate, and the combination has substantial activity in preventing acute GVHD after unrelated donor marrow transplantation.

Predicting Steroid Refractroy Acute Gastrointestinal (GI) Acute Graft Versus Host Disease (AGVHD) by Assessment of Crypt Loss at Diagnosis.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 2895-2895
Author(s):  
Joshua Melson ◽  
Ali Keshavarzian ◽  
Shriram Jakate ◽  
Sally Arai ◽  
Stephanie A. Gregory ◽  
...  
Keyword(s):  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Graft Versus Host Disease ◽  
Cell Transplant ◽  
Host Disease ◽  
Graft Versus Host ◽  
Risk Of Death ◽  
Steroid Refractory ◽  
Acute Graft

Abstract Acute graft versus host disease accounts for most of the treatment failures after an allogeneic stem cell transplantation. The prognosis of patients with steroid refractory acute graft versus host disease is poor with conventional treatment. Early identification of patients with steroid refractory acute graft versus host disease may improve the transplant outcomes. Crypt loss has been associated with the severity of disease in patients with inflammatory bowel disease. It is also found in patients with acute gastrointestinal graft versus host disease with unknown clinical significance. In an attempt to evaluate the significance of crypt loss in patients with acute gastrointestinal graft versus host disease, we conducted a retrospective study on 22 consecutive post allogeneic stem cell transplant patients in our institution that underwent colonoscopy and colonic biopsy. In this study, crypt loss was graded and correlated with clinical parameters of disease severity including stool volume, endoscopic appearance, response to graft versus host disease treatment and one year mortality attributed to graft versus host disease. All the biopsies were reviewed by one of the co-authors (Shriram Jakate, M.D.). Twenty two consecutive patients who were treated for gastrointestinal graft versus host disease following stem cell transplantation were studied. Crypt loss was present in 16/22 cases and in 10/22 cases crypt loss was determined to be severe by the presence of contiguous areas of crypt loss. In those with severe crypt loss 9/10 patients had daily stool volumes in excess of 1000 ml/day while only 3/6 in those with minimal crypt loss had this level of severe diarrhea. Patients with severe crypt loss were more likely to have a pathologic appearance at endoscopy and to require second-line therapy (i.e. steroid refractory acute graft versus host disease). The diarrhea of those with severe crypt loss was less likely to resolve even though it was more aggressively treated. Of the 10 patients with severe crypt loss, 5 (50%) died of graft versus host disease related causes. Conversely, only one of 12 patients (8%) with mild or no crypt loss had a death attributable to acute graft versus host disease. Our study shows that severe crypt loss predicts for severity of acute gastrointestinal graft versus host disease, response to treatment and more importantly steroid refractoriness. In addition, crypt loss severity is associated with an increased risk of death related to acute graft versus host disease. We conclude that the assessment of crypt loss at diagnosis may serve as a tool to identify patients with steroid refractory acute gastrointestinal graft versus host disease and could be used to select patients for therapeutic trial in acute graft versus host disease.

Subcutaneous Alemtuzumab May Be Useful in the Treatment of Steroid-Refractory Acute Graft-Versus-Host Disease.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 2983-2983
Author(s):  
David Gomez-Almaguer ◽  
Guillermo J. Ruiz-Arguelles ◽  
Oscar Gonzalez-Llano ◽  
Homero C. Gutierrez-Aguire ◽  
Olga G. Cantu-Rodriguez ◽  
...  
Keyword(s):  
T Lymphocytes ◽  
Graft Versus Host Disease ◽  
Acute Gvhd ◽  
Chronic Gvhd ◽  
Allogeneic Transplantation ◽  
Host Disease ◽  
Graft Versus Host ◽  
Grade Ii ◽  
Steroid Refractory ◽  
Acute Graft

Abstract Background: Acute graft-versus-host disease (GvHD) is mediated by activated T lymphocytes. Alemtuzumab is an unconjugated, humanized IgG1 kappa monoclonal antibody which targets the CD52 antigen on T lymphocytes and other cells and has been used successfully in conditioning regimens for allogeneic transplantation to remove donor T cells so as to prevent GvHD. Patients and methods: Eighteen patients with steroid-refractory acute GvHD ≥ grade II were analyzed to evaluate the safety and efficacy of alemtuzumab. The patients received subcutaneous alemtuzumab 10 mg daily on days 1–5. The proportion of patients with grade II, III and IV were eight, eight and two, respectively. The main organ involved was the liver in four, gut in five, skin and liver in three, and skin and gut in three patients. Results: Fifteen out of 18 patients (83%) responded to alemtuzumab with 6 (33%) complete and 9 (50%) partial responses. All three unresponsive patients died of GvHD. Ten of 15 responders are alive at a median follow-up of 9 months (range 2–23) after alemtuzumab, with limited, extensive and no signs of chronic GvHD in 1, 4, and 5 patients, respectively. Fourteen patients (78%) developed some kind of infection; eleven of them developed cytomegalovirus reactivation. All patients tolerated alemtuzumab with minimal side effects; grade 3 neutropenia and thrombocytopenia were seen in six and four patients, respectively. Conclusions: Alemtuzumab is a well tolerated agent and has a beneficial effect in the treatment of steroid-refractory acute GvHD. Infections are common and anti-infective prophylaxis is mandatory.

Biosimilar infliximab administration for the management of acute graft-versus-host disease

2020 ◽  
Vol 26 (8) ◽  
pp. 2047-2051
Author(s):  
Eris Tollkuci ◽  
Paul Fitzpatrick ◽  
Amanda N Seddon ◽  
Rebecca Myers ◽  
Sunita Nathan ◽  
...  
Keyword(s):  
Case Report ◽  
Graft Versus Host Disease ◽  
Treatment Options ◽  
Cell Transplant ◽  
Hematopoietic Stem ◽  
Host Disease ◽  
Graft Versus Host ◽  
First Case ◽  
Steroid Refractory ◽  
Acute Graft

Introduction Acute graft-versus-host disease (aGVHD) is a significant immune-mediated complication of allogeneic hematopoietic stem cell transplant (HSCT). Despite prophylactic immunosuppression, the incidence of grades II–IV aGVHD post-HSCT varies from 20 to 80%. Tumor necrosis factor (TNF) is an important cytokine involved in the pathogenesis of GVHD, and medications such as infliximab (Remicade®) have been utilized as second-line treatment options in patients with steroid-refractory GHVD. Infliximab-dyyb (Inflectra®) and infliximab-qbtx (Ixifi®) are biosimilars approved by the FDA for a variety of autoimmune disorders. This is the first case report documenting the utility of infliximab-dyyb and -qbtx for the management of steroid-refractory aGVHD. Case report We report the post-transplant course of three patients treated with infliximab biosimilars as a part of therapy for management of steroid-refractory aGVHD. Management and outcome Steroid-refractory aGVHD is associated with poor prognosis and its management, as highlighted in our three patient cases, and can be very diverse often requiring different therapeutic modalities which overlap in administration. Discussion In these patients with steroid-refractory aGVHD, we were able to show that infliximab biosimilars could be used in lieu of the reference infliximab product. Although we had important limitations, this case report supports the use of anti-TNF agents in highly mortal steroid-refractory acute GI GVHD and that replacement of infliximab with its biosimilars is feasible.

scholarly journals Fecal Microbiota Transplantation for Treating Steroid-Refractory Acute Graft-versus-Host Disease of the Gut

2021 ◽  
Vol 96 (4) ◽  
pp. 358-362
Author(s):  
Sang Hoon Yeon ◽  
Myung-Won Lee ◽  
Deog-Yeon Jo ◽  
Bu-Yeon Heo ◽  
Jaeyul Kwon ◽  
...  
Keyword(s):  
Graft Versus Host Disease ◽  
Acute Gvhd ◽  
Fecal Microbiota Transplantation ◽  
Fecal Microbiota ◽  
Hematopoietic Stem ◽  
Host Disease ◽  
Fecal Microbiome ◽  
Graft Versus Host ◽  
Steroid Refractory ◽  
Acute Graft

Restoring the microbiota via fecal microbiota transplantation (FMT) can be an effective treatment for steroid-refractory acute graft-versus-host disease (GVHD) of the gut. Here, we report two adult patients who underwent FMT to treat steroid-refractory acute GVHD of the gut. The first patient was a 43-year-old man who underwent allogeneic hematopoietic stem cell transplantation (HSCT) with cells from a matched sibling donor. The second patient was a 70-year-old woman who underwent haplo-identical HSCT with cells from her son. Gut GVHD developed at 7 and 4 weeks after HSCT, respectively. After undergoing FMT, the clinical symptoms improved; the first patient had a complete response and the second patient had a partial response. Microbial analyses using RNA gene sequencing showed that a diverse fecal microbiome was recovered by 4 weeks after FMT. FMT should be considered an effective therapeutic option for managing steroid-refractory acute GVHD of the gut.

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