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Alemtuzumab as salvage therapy for steroid and ATG/etanercept-refractory acute GVHD

Bone Marrow Transplantation volume 46, pages 1579–1580 (2011)Cite this article

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Acute GVHD (aGVHD) refractory to initial treatment with corticosteroids is associated with high rates of morbidity and mortality.1, 2, 3, 4, 5 Although several different agents have been proposed as therapy for steroid-refractory aGVHD, there remains no consensus as to optimal management following failure of corticosteroids. At our institution, steroid-refractory aGVHD is routinely treated with anti-thymocyte globulin (ATG), etanercept±mycophenolate mofetil.5 Although this approach is able to salvage a significant proportion of patients, prognosis is historically dismal in those patients refractory to second-line therapy. Given the reports of steroid-refractory aGVHD responding to alemtuzumab,1, 2, 3, 4, 6, 7 we have incorporated this agent as third-line therapy in patients failing the above strategies. Herein, we report the outcome of 13 patients with steroid and ATG/etanercept-refractory aGVHD treated with alemtuzumab as third-line therapy at our institution.

Patients were identified retrospectively from an institutional database and clinical outcomes determined by review of medical records. GVHD diagnosis was biopsy proven and clinically graded according to the Gluksberg criteria.8 Steroid-refractory aGVHD was defined as progressive GVHD after 3 days of methylprednisolone ⩾2 mg/kg/day, no change in GVHD grade after 7 days of methylprednisolone, 50 mg of prednisolone per day. In second-line therapy with ATG, etanercept±mycophenolate mofetil was delivered as previously published.5 Alemtuzumab was administered at 10 mg s.c. daily for five consecutive days in patients who failed to respond to second-line therapy, as defined by progressive GVHD at any time post ATG/etanercept, no response at 14 days or <CR at 28 days post second-line therapy. Response to alemtuzumab was assessed after 28 days or at the time of death if earlier; CR was defined as resolution of all signs and symptoms of aGVHD (Grade 0) and PR as reduction in severity of GVHD by at least 1 overall grade.

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Authors and Affiliations

  1. Department of Haematology, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia,

    K Jackson, C Curley, J Leach, A McLean, S Durrant & G A Kennedy

  2. Department of Pharmacy, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia,

    M Nakagaki

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  1. K Jackson
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  2. C Curley
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  3. J Leach
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  4. A McLean
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  5. M Nakagaki
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  6. S Durrant
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  7. G A Kennedy
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Correspondence to G A Kennedy.

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Jackson, K., Curley, C., Leach, J. et al. Alemtuzumab as salvage therapy for steroid and ATG/etanercept-refractory acute GVHD. Bone Marrow Transplant 46, 1579–1580 (2011). https://doi.org/10.1038/bmt.2010.341

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