1. ¹Department of Haematology and Oncology, University of Rostock, Rostock, Germany
2. ²Department of Haematology/Oncology, University Hospital of Regensburg, Regensburg, Germany
3. ³Department of Internal Medicine III, Campus Benjamin Franklin, Charité – University Hospital Berlin, Berlin, Germany

Correspondence: Dr D Wolff, Department of Haematology and Oncology, University of Rostock, E Heydemann Str. 6, 18057 Rostock, Germany. E-mail: daniel.wolff@medizin.uni-rostock.de

Received 17 January 2006; Revised 8 June 2006; Accepted 13 June 2006.

Abstract

Transplantation-associated microangiopathy (TAM) or renal insufficiency (RI) after allogeneic hematopoietic stem cell transplantation is associated with a high mortality. As calcineurin inhibitors (CI) may contribute to TAM or RI, we evaluated the efficacy of replacing CI by daclizumab in patients with graft-versus-host disease (GVHD). Thirteen patients with GVHD-associated TAM and five patients with RI were treated with daclizumab 1 mg/kg intravenous (i.v.)/week, discontinuation of the CI and continuation of the remaining GVHD treatment. All patients had acute GVHD (steroid-sensitive (n=4), steroid-refractory (n=10)) or chronic GVHD (n=4) and were treated with CI before the start of daclizumab. Nine of 13 patients with TAM treated with daclizumab and discontinuation of CI achieved complete remission of TAM, two had stable disease, and one patient did not respond. Patients receiving daclizumab for RI without TAM showed stabilization (2/5) or improvement (3/5) of renal function. Four of 14 patients with acute GVHD achieved CR, two partial remission, eight patients did not respond and 11/14 died at a median of 39 days after start of the daclizumab. Our data demonstrate that replacement of CI by daclizumab can improve TAM and RI. However, mortality remains high in patients with acute GVHD.