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Graft-versus-Host Disease

Infliximab for GVHD therapy in children

Bone Marrow Transplantation volume 40, pages 473–480 (2007)Cite this article

Abstract

GVHD remains a significant complication of allogeneic hematopoietic stem cell transplantation. Tumor necrosis factor-α (TNF-α) is a major mediator of GVHD pathogenesis. Infliximab inhibits the binding of TNF-α with its cellular receptors and has been associated with encouraging responses in adults with severe GVHD. We retrospectively evaluated the efficacy and safety of infliximab 10 mg/kg i.v. once a week for a median of eight doses (range 1–162) in 24 children with steroid-resistant GVHD. The overall response rate in 22 evaluable children was 82% (12 CR+6 PR). Among those patients with acute GVHD, both skin and gastrointestinal involvement responded well to infliximab; however long-term outcome was poor. While infliximab may be useful to acutely control GVHD manifestations, GVHD recurs commonly upon discontinuation of infliximab. Within 100 days of the final infliximab dose, 77% of patients had bacterial infections, 32% had viral infections and 13.6% had probable or proven non-candidal invasive fungal infections. Infliximab appears to be well-tolerated and to have activity in steroid-resistant GVHD. Controlled studies to assess the pharmacokinetics and most effective dosing regimen of infliximab for the treatment of GVHD are warranted.

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Author information

Authors and Affiliations

  1. Department of Pediatrics, Section of Pediatric Hematology/Oncology, Yale University, New Haven, CT, USA

    B S Sleight

  2. Division of Pediatric Stem Cell Transplantation, Texas Transplant Institute, San Antonio, TX, USA

    K W Chan

  3. Department of Biostatistics, University of Michigan, Ann Arbor, MI, USA

    T M Braun

  4. Division of Pediatric Hematology/Oncology, Department of Pediatrics, Children's Mercy Hospital, Kansas City, MO, USA

    A Serrano

  5. Division of Pediatric Hematology/Oncology, Department of Pediatrics, University of North Carolina, Chapel Hill, NC, USA

    A L Gilman

Authors
  1. B S Sleight
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  2. K W Chan
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  3. T M Braun
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  4. A Serrano
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  5. A L Gilman
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Corresponding author

Correspondence to A L Gilman.

Additional information

These data were presented at the American Society for Blood and Marrow Transplantation meeting at Keystone, CO, USA, in January 2004.

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Sleight, B., Chan, K., Braun, T. et al. Infliximab for GVHD therapy in children. Bone Marrow Transplant 40, 473–480 (2007). https://doi.org/10.1038/sj.bmt.1705761

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