Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Graft-Versus-Host-Disease

Daclizumab for children with corticosteroid refractory graft-versus-host disease

Abstract

Daclizumab, a humanized IL-2 receptor antagonist, has been found to be safe and effective in adults with refractory graft-versus-host disease (GVHD); however, data describing its efficacy for refractory GVHD in children are limited. We report a series of 14 children who were treated with daclizumab for severe acute and/or chronic corticosteroid refractory GVHD. Patients were treated with 2 mg/kg weekly for 8 weeks followed by 1 mg/kg weekly for 4 weeks. Nine of 14 patients responded to daclizumab as measured by improvement of GVHD symptoms, and the ability to substantially wean corticosteroid dose. Five of 11 patients with acute GVHD had complete symptom resolution, and 2/11 had a partial response. Two of four patients with chronic GVHD had complete symptom resolution. In these patients, daclizumab was only effective in treating skin GVHD. Seven of the nine patients who had a complete or partial response eventually had recurrence of GVHD; however, the GVHD was less severe and no longer corticosteroid refractory. There was no infusional toxicity, and no infections that could be attributable to the drug. Daclizumab is a relatively safe and effective medication for corticosteroid refractory GVHD in children and larger studies are needed to evaluate its role in treatment.

This is a preview of subscription content, access via your institution

Access options

Buy this article

Prices may be subject to local taxes which are calculated during checkout

Similar content being viewed by others

References

  1. Ferrara JL, Cooke KR, Teshima T . The pathophysiology of acute graft-versus-host disease. Int J Hematol 2003; 78: 181–187.

    Article  CAS  Google Scholar 

  2. Przepiorka D, Kernan NA, Ippoliti C, Papadopoulos EB, Giralt S, Khouri I et al. Daclizumab, a humanized anti-interleukin-2 receptor alpha chain antibody, for treatment of acute graft-versus-host disease. Blood 2000; 95: 83–89.

    CAS  Google Scholar 

  3. Swiatecka-Urban A . Anti-interleukin-2 receptor antibodies for the prevention of rejection in pediatric renal transplant patients: current status. Paediatr Drugs 2003; 5: 699–716.

    Article  Google Scholar 

  4. van Mourik ID, Kelly DA . Immunosuppressive drugs in paediatric liver transplantation. Paediatr Drugs 2001; 3: 43–60.

    Article  CAS  Google Scholar 

  5. Willenbacher W, Basara N, Blau IW, Fauser AA, Kiehl MG . Treatment of steroid refractory acute and chronic graft-versus-host disease with daclizumab. Br J Haematol 2001; 112: 820–823.

    Article  CAS  Google Scholar 

  6. Srinivasan R, Chakrabarti S, Walsh T, Igarashi T, Takahashi Y, Kleiner D et al. Improved survival in steroid-refractory acute graft-versus-host disease after non-myeloablative allogeneic transplantation using a daclizumab-based strategy with comprehensive infection prophylaxis. Br J Haematol 2004; 124: 777–786.

    Article  CAS  Google Scholar 

  7. Wolff D, Roessler V, Steiner B, Wilhelm S, Weirich V, Brenmoehl J et al. Treatment of steroid-resistant acute graft-versus-host disease with daclizumab and etanercept. Bone Marrow Transplant 2005; 35: 1003–1010.

    Article  CAS  Google Scholar 

  8. Pietra BA, Boucek MM . Immunosuppression for pediatric cardiac transplantation in the modern era. Prog Pediatr Cardiol 2000; 11: 115–129.

    Article  CAS  Google Scholar 

  9. Abu-Elmagd K, Fung J, McGhee W, Martin D, Mazariegos G, Schaefer N et al. The efficacy of daclizumab for intestinal transplantation: preliminary report. Transplant Proc 2000; 32: 1195–1196.

    Article  CAS  Google Scholar 

  10. Anasetti C, Hansen JA, Waldmann TA, Appelbaum FR, Davis J, Deeg HJ et al. Treatment of acute graft-versus-host disease with humanized anti-Tac: an antibody that binds to the interleukin-2 receptor. Blood 1994; 84: 1320–1327.

    CAS  Google Scholar 

  11. website F . www.fda.gov/medwatch/SAFETY/2003/zenapax.htm.

  12. Church AC . Clinical advances in therapies targeting the interleukin-2 receptor. Qjm 2003; 96: 91–102.

    Article  CAS  Google Scholar 

  13. Lee SJ, Zahrieh D, Agura E, MacMillan ML, Maziarz RT, McCarthy Jr PL . et al. Effect of up-front daclizumab when combined with steroids for the treatment of acute graft-versus-host disease: results of a randomized trial. Blood 2004; 104: 1559–1564.

    Article  CAS  Google Scholar 

  14. Pescovitz MD, Bumgardner G, Gaston RS, Kirkman RL, Light S, Patel IH et al. Pharmacokinetics of daclizumab and mycophenolate mofetil with cyclosporine and steroids in renal transplantation. Clin Transplant 2003; 17: 511–517.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to D T Teachey.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Teachey, D., Bickert, B. & Bunin, N. Daclizumab for children with corticosteroid refractory graft-versus-host disease. Bone Marrow Transplant 37, 95–99 (2006). https://doi.org/10.1038/sj.bmt.1705199

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/sj.bmt.1705199

Keywords

This article is cited by

Search

Quick links