Abstract
Daclizumab has been shown to have activity in acute GVHD, but appears to be associated with an increased risk of infection. To investigate further the long-term effects of daclizumab, we performed a retrospective review of 57 patients who underwent an allogeneic hematopoietic stem cell transplant from January 1993 through June 2000 and were treated with daclizumab for steroid-refractory acute GVHD. The median number of daclizumab doses given was 5 (range 1–22). GVHD was assessed at baseline, days 15, 29 and 43. By day 43, 54% patients had an improvement in their overall GVHD score, including 76% patients aged ⩽18. Opportunistic infections developed in 95% patients. Forty-three patients (75%) died following treatment with daclizumab. The causes of death included active GVHD and infection (79%), active GVHD (5%), chronic GVHD (2%) and relapse (14%). Patients with grade 3–4 GVHD had a significantly shorter median survival than patients with grade 1–2 GVHD (2.0 vs 5.1 months, P=0.001). Daclizumab has no infusion-related toxicity, is active in steroid-refractory GVHD, especially among pediatric patients, but is associated with significant morbidity and mortality due to infectious complications. Careful patient selection and aggressive prophylaxis against viral and fungal infections are recommended.
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Acknowledgements
Supported in part by P01 CA23766. Additional support by the Charles A Dana Fellowship (MAP, DMW), the Clinical Scholars Biomedical Research Training Program (MAP, DMW), NIH CA09512 (MAP, DMW) and NIH CA09207, CA10260 (MAP) and the Leukemia and Lymphoma Society 5415-05 (DMW).
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Perales, MA., Ishill, N., Lomazow, W. et al. Long-term follow-up of patients treated with daclizumab for steroid-refractory acute graft-vs-host disease. Bone Marrow Transplant 40, 481–486 (2007). https://doi.org/10.1038/sj.bmt.1705762
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DOI: https://doi.org/10.1038/sj.bmt.1705762
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