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Safety and Efficacy of Infliximab Therapy in the Setting of Steroid-Refractory Acute Graft-versus-Host Disease.
- Source :
-
Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation [Biol Blood Marrow Transplant] 2017 Sep; Vol. 23 (9), pp. 1478-1484. Date of Electronic Publication: 2017 May 08. - Publication Year :
- 2017
-
Abstract
- Acute graft-versus-host disease (aGVHD) is the leading cause of morbidity and mortality after allogenic hematopoietic cell transplantation (HCT). Corticosteroids are the first-line treatment; however, less than one-half of patients achieve durable remission. Studies suggest that TNF-α, a cytokine released from the bone marrow during conditioning, is involved in the pathogenesis of aGVHD. We retrospectively evaluated the outcome of anti-TNF-α therapy with infliximab in 35 patients with steroid refractory (SR) aGVHD. Infliximab was administered intravenously at 10 mg/kg for a median of 4 doses (range, 1 to 6) on a weekly basis. The overall response rates were 40% (17% complete response [CR], 23% partial response [PR]) at 4 weeks, 23% (9% CR, 14% PR) at 8 weeks, and 17% (all CR) at 12 weeks. Twenty-nine (83%) patients had infectious complications within 12 weeks of initiation of infliximab. These infections included 40 bacterial infections, 6 invasive fungal infections, and 5 viral reactivations. Twelve patients (34%) died secondary to infections. Overall survival at 12 weeks and 6 months from the start of infliximab therapy was 37% (13 of 35) and 17% (6 of 35), respectively; with most deaths secondary to complications from GVHD and infections. In conclusion; the use of infliximab therapy in patients with SR-aGVHD is associated with a modest poorly sustained response along with a heightened risk of severe infections. Future studies with more effective and less toxic therapies are needed for these patients.<br /> (Copyright © 2017 The American Society for Blood and Marrow Transplantation. Published by Elsevier Inc. All rights reserved.)
- Subjects :
- Acute Disease
Adrenal Cortex Hormones therapeutic use
Adult
Aged
Bacterial Infections etiology
Bacterial Infections immunology
Bacterial Infections mortality
Bacterial Infections pathology
Bone Marrow drug effects
Bone Marrow immunology
Bone Marrow pathology
Drug Administration Schedule
Female
Graft vs Host Disease immunology
Graft vs Host Disease mortality
Graft vs Host Disease pathology
Hematologic Neoplasms immunology
Hematologic Neoplasms mortality
Hematologic Neoplasms pathology
Humans
Infliximab adverse effects
Injections, Intravenous
Male
Middle Aged
Mycoses etiology
Mycoses immunology
Mycoses mortality
Mycoses pathology
Retrospective Studies
Survival Analysis
Transplantation, Homologous
Treatment Outcome
Tumor Necrosis Factor-alpha antagonists & inhibitors
Tumor Necrosis Factor-alpha biosynthesis
Tumor Necrosis Factor-alpha immunology
Virus Diseases etiology
Virus Diseases immunology
Virus Diseases mortality
Virus Diseases pathology
Graft vs Host Disease therapy
Hematologic Neoplasms therapy
Hematopoietic Stem Cell Transplantation
Infliximab administration & dosage
Myeloablative Agonists adverse effects
Transplantation Conditioning adverse effects
Subjects
Details
- Language :
- English
- ISSN :
- 1523-6536
- Volume :
- 23
- Issue :
- 9
- Database :
- MEDLINE
- Journal :
- Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation
- Publication Type :
- Academic Journal
- Accession number :
- 28495641
- Full Text :
- https://doi.org/10.1016/j.bbmt.2017.05.001