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Graft-Versus-Host Disease

Long-term follow-up of corticosteroid refractory acute GVHD treated with an Inolimomab-based algorithm: a single center experience

Bone Marrow Transplantation volume 48, pages 1243–1248 (2013)Cite this article

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Abstract

Acute corticosteroid refractory GVHD (aGVHD) remains a challenging problem after allogeneic hematopoietic SCT. Even though immunosuppressive therapies may achieve a response, unsatisfactory aGVHD control and toxicity of high cumulative doses of corticosteroids are frequent, notably with an increased infection rate. We report long-term follow-up of 33 consecutive patients who developed corticosteroid refractory aGVHD in our institution, treated homogeneously according to a unique algorithm combining an induction treatment (Inolimomab, 0.3 mg/kg per day), an associated immunosuppression (Mycophenolate Mofetil) and a predefined management of partial responses (PR) by the switch from Cyclosporin to Tacrolimus, together with an intensive infectious monitoring and supportive care. In this cohort, 17 patients (52%) achieved a complete response (CR) and 14 patients (42%) a PR, which converted to CR for 12 patients after Tacrolimus introduction. Transplant related mortality (TRM) was 15.5% and 29.7% at 1 and 3 years, respectively. OS was 54.5% at 3 years. Multivariate analysis identified CR after Inolimomab therapy as the unique prognostic factor on OS. Among the 30 evaluable patients, 19 (63%) developed extensive chronic GVHD. This Inolimomab-based algorithm allows for an efficient control of corticosteroid refractory aGVHD in a high proportion of patients with low toxicity, and deserves further investigation.

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Acknowledgements

We thank Dr Emmanuel GYAN (Department of Hematology and Cellular Therapy, Hôpital Bretonneau, Tours) and Dr Régis PEFFAULT de la TOUR (Hematology-BMT, Hôpital Saint Louis, Paris) for their critical reading of the manuscript. We are grateful to EUSA Pharma for computer support and to Association Pictave pour l′ Etude des Maladies du Sang (APEMSA) for financial support.

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Authors and Affiliations

  1. Department of Haematology and Oncology, Centre Hospitalier de Poitiers, Poitiers, France

    S Girerd, C Giraud, R Larchee & F Guilhot

  2. Department of Haematology and Cellular Therapy, Centre Hospitalier Bretonneau, Tours, France

    M Renaud

  3. Inserm CIC 0802, Centre Hospitalier de Poitiers, Poitiers, France

    J Guilhot & F Guilhot

  4. HLA Laboratory, Etablissement Français du Sang de Poitiers, Poitiers, France

    I Jollet

  5. Laboratoire therapie cellulaire EFS-CA, site de Poitiers, Poitiers, France

    C Giraud

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Correspondence to F Guilhot.

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Girerd, S., Renaud, M., Guilhot, J. et al. Long-term follow-up of corticosteroid refractory acute GVHD treated with an Inolimomab-based algorithm: a single center experience. Bone Marrow Transplant 48, 1243–1248 (2013). https://doi.org/10.1038/bmt.2013.16

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