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Successful use of Campath-1H in the treatment of steroid refractory liver GvHD

Bone Marrow Transplantation volume 34, pages 285–287 (2004)Cite this article

Graft-versus-host disease (GvHD) is one of the major limitations to successful haematopoietic stem cell transplantation and occurs in 20–90% of patients following allogeneic stem cell transplant.1 Corticosteroids are the backbone of most treatment regimens for acute GvHD, but fewer than 50% of patients show a durable response to corticosteroids.2 Steroid-resistant acute GvHD is associated with high morbidity and mortality and is extremely difficult to manage.3 Various pharmacological agents like antithymocyte globulin4 and mycophenolate mofetil5 have been used with variable responses. Recently, a number of monoclonal antibodies (anti-IL-1, anti-TNF, anti-IL-2 and anti-CD3 antibody) have been tried in steroid refractory acute GvHD with mixed results.6

Campath-1H (Alemtuzumab) is a humanised monoclonal antibody to CD52, an antigen expressed by T and B lymphocytes, eosinophils, monocytes and some antigen-presenting dendritic cells (DCs).7 It has been used in conditioning regimens for allogeneic transplantation to remove donor T cells so as to prevent GvHD.8 The induction of acute GvHD requires host antigens to be presented to donor T cells by antigen-presenting cells (APCs), such as DCs. As it is now reported that CD52 antigen is also present on monocyte-derived peripheral blood DCs,7 it is now reasoned that Campath-1H might have a direct effect on DCs, in addition to donor T cells, both for the prevention and treatment of acute GvHD. We describe two patients who developed acute liver GvHD following allogeneic stem cell transplantation and were successfully treated with Campath-1H.

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  1. Department of Haematology, Bone Marrow Transplant Unit, University Hospital Birmingham NHS Trust, Birmingham, UK

    F Wandroo, B Auguston, M Cook, C Craddock & P Mahendra

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  1. F Wandroo
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  2. B Auguston
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  3. M Cook
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  4. C Craddock
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  5. P Mahendra
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Wandroo, F., Auguston, B., Cook, M. et al. Successful use of Campath-1H in the treatment of steroid refractory liver GvHD. Bone Marrow Transplant 34, 285–287 (2004). https://doi.org/10.1038/sj.bmt.1704573

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