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Graft-versus-host Disease

Human chorionic gonadotropin and indolamine 2,3-dioxygenase in patients with GVHD

Bone Marrow Transplantation volume 49, pages 800–805 (2014)Cite this article

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Abstract

GVHD is a major complication following allogeneic hematopoietic SCT, and is associated with substantial morbidity and mortality. Based on the results of our previous clinical study with females treated with human chorionic gonadotropin (hCG) as preconditioning therapy for in vitro fertilization, we hypothesized that low-dose hCG stimulates indoleamine-2,3-dioxygenase (IDO), IL 10 and regulatory T cells (Treg), thereby suppressing clinical manifestations of chronic GVHD. Active chronic GVHD localized at skin, subcutaneous tissue, joints orgastrointestinal tract that was refractory or intolerant to glucocorticoid therapy improved substantially in 12 of 20 patients treated with hCG for 8 weeks (off-label), enabling a glucocorticoid dose reduction of 28% (average). Twelve of 19 patients with chronic GVHD of the skin responded to hCG therapy with a reduction of 25% (average) in their total skin score. HCG treatment increased IDO expression at median by sevenfold in peripheral mononuclear cells and IL10 levels in serum up to twofold at median from the pretreatment baseline. Further, an expansion of the Treg cell population was measured in one patient, which is also associated with the induction of tolerance. This novel application of low-dose hCG was well tolerated and is of clinical interest for GVHD treatment.

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Acknowledgements

We thank Martina Franke, Silke Maag and Roberta Frese for expert technical assistance and the WTZ Research Support Service (supported in part by the Deutsche Krebshilfe Comprehensive Cancer Center financing) for manuscript editing.

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Authors and Affiliations

  1. Department of Hematology and Oncology, Helios Klinik Schwerin, Schwerin, Germany

    A H Elmaagacli

  2. Department of Bone Marrow Transplantation (AHE), West German Cancer Center, all University Hospital Essen, Essen, Germany

    M Ditschkowski, N K Steckel, T Gromke, H Ottinger, R Trenschel, D W Beelen & M Koldehoff

  3. Department of Dermatology, all University Hospital Essen, Essen, Germany

    U Hillen

  4. Institute of Pathology, all University Hospital Essen, Essen, Germany

    H A Baba

Authors
  1. A H Elmaagacli
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Correspondence to A H Elmaagacli.

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Elmaagacli, A., Ditschkowski, M., Steckel, N. et al. Human chorionic gonadotropin and indolamine 2,3-dioxygenase in patients with GVHD. Bone Marrow Transplant 49, 800–805 (2014). https://doi.org/10.1038/bmt.2014.59

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