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Poor prognosis in patients with steroid refractory acute graft versus host disease treated with etanercept: a multi-centre analysis

Bone Marrow Transplantation volume 53, pages 1478–1482 (2018)Cite this article

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Patients with steroid refractory acute GVHD (SR-GVHD) have a dismal prognosis, with a 5-year mortality rate of approximately 70% [1]. Currently, no single agent has been able to show superiority over others to be established as a standard second-line therapy [2]. Inhibition of TNF–α by etanercept is an attractive strategy to treat SR-GVHD. However, large-scale clinical studies that evaluate the efficacy of etanercept in this setting are lacking [3,4,5]. There is also a dearth of information with respect to identifying predictors of clinical response and survival.

In this study, we have assessed the outcomes of allogeneic stem cell transplant recipients who developed grade II-IV SR-GVHD and received etanercept. Patients were recruited from St Vincent’s Hospital between April 2006 and July 2015, and from Hospital de la Santa Creu i Sant Pau and Hospital Vall Hebrón between November 2013 and April 2016. All patients provided informed consent. Diagnosis and grading of acute GVHD was based on previously published criteria [6, 7]. All patients who developed SR-GVHD within 100 days post transplantation were included. Failure of steroid treatment was defined as progression of acute GVHD grade by day 3 of steroid therapy, absence of response by day 5, or inability to achieve a complete response (CR) by day 14. The treatment regimen included subcutaneous injection of 25 mg etanercept, twice a week for 4 weeks, followed by once a week for 4 weeks. For a proportion of patients, further doses of etanercept were administered as per treating physician’s discretion.

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Acknowledgements

JS is supported by the Catalan Government (AGAUR 2014 SGR 1281 and PERIS SLT002/16/00433) and by the Instituto de Salud Carlos III, Ministerio de Economía y Competitividad, Spain (RD12/0036/0071 and PI17/01246).

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Authors and Affiliations

  1. Haematology Department, St Vincent’s Hospital, Sydney, Australia

    Chun Kei Kris Ma, Sylvia Ai, Ian Nivison-Smith, Samuel Thomas Milliken, Anthony Dodds, Keith Fay, David D. F. Ma & John Moore

  2. Faculty of Medicine, University of New South Wales, Sydney, Australia

    Chun Kei Kris Ma, David D. F. Ma & John Moore

  3. Hematology Department, Hospital de la Santa Creu i Sant Pau, IIB Sant Pau and Jose Carreras Leukemia Research Institutes, Universidad Autónoma de Barcelona, Barcelona, Spain

    Irene García-Cadenas, Rodrigo Martino & Jorge Sierra

  4. Haematology Department, Hospital Universitario Vall d’Hebrón, Barcelona, Spain

    María Laura Fox

  5. Australasian Bone Marrow Transplant Recipient Registry (ABMTRR), St Vincent’s Hospital, Sydney, Australia

    Ian Nivison-Smith

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  1. Chun Kei Kris Ma
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Correspondence to Chun Kei Kris Ma.

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Ma, C.K.K., García-Cadenas, I., Fox, M.L. et al. Poor prognosis in patients with steroid refractory acute graft versus host disease treated with etanercept: a multi-centre analysis. Bone Marrow Transplant 53, 1478–1482 (2018). https://doi.org/10.1038/s41409-018-0215-4

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  • DOI: https://doi.org/10.1038/s41409-018-0215-4

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