Updated Experience with Inolimomab as Treatment for Corticosteroid-Refractory Acute Graft-versus-Host Disease
Por:
Garcia-Cadenas, I, Valcarcel, D, Martino, R, Pinana, JL, Novelli, S, Esquirol, A, Garrido, A, Moreno, ME, Granell, M, Moreno, C, Saavedra, S, Briones, J, Brunet, S, Sierra, J
Publicada:
1 mar 2013
Resumen:
Refractory acute graft-versus-host disease (aGVHD) remains an important cause of mortality after allogeneic stem cell transplantation. No standard therapy exists once steroids fail to obtain a good response. In 2006, our group published a series of patients who received inolimomab, an anti-interleulcin-2 receptor monoclonal antibody, as salvage therapy with initial encouraging results. In this update, we analyzed a larger group of patients with prolonged follow-up. Ninety-two consecutive patients were treated with inolimomab at our center between April 1999 and December 2011. Overall response rate was 42% (complete response in 14%) on day +30. Predictors of failure to respond in the multivariate analysis were overall aGVHD grade IV, instauration of inolimomab before day 15 of aGVHD diagnosis, and severe lymphopenia. Patients without gastrointestinal involvement appeared to do better, with a 70% response rate compared with 39% in patients with gastrointestinal involvement (P = .06). However, the 2-year overall survival rate was of 18% for the entire cohort (95% confidence interval, 10% to 26%) and 33% for day 30 responders (95% confidence interval, 25% to 40%) and Acute GVHD was the main cause of death (49%) followed by opportunistic infections (27%). Results of this update show that although inolimomab is a well-tolerated drug with a moderate number of short-term responses, it is associated with long-term survival in only one-third of responding patients. These data highlight the need to investigate new rescue treatments with sustained effect and the importance of reporting long-term outcomes in GVHD studies. (C) 2013 American Society for Blood and Marrow Transplantation.
Filiaciones:
Garcia-Cadenas, I:
Univ Autonoma Barcelona, Hosp Santa Creu & St Pau, E-08193 Barcelona, Spain
Valcarcel, D:
Univ Autonoma Barcelona, Hosp Santa Creu & St Pau, E-08193 Barcelona, Spain
Univ Autonoma Barcelona, Hosp Vall dHebron, E-08193 Barcelona, Spain
Martino, R:
Univ Autonoma Barcelona, Hosp Santa Creu & St Pau, E-08193 Barcelona, Spain
Pinana, JL:
Univ Autonoma Barcelona, Hosp Santa Creu & St Pau, E-08193 Barcelona, Spain
Hosp Manises, Valencia, Spain
Novelli, S:
Univ Autonoma Barcelona, Hosp Santa Creu & St Pau, E-08193 Barcelona, Spain
Esquirol, A:
Univ Autonoma Barcelona, Hosp Santa Creu & St Pau, E-08193 Barcelona, Spain
Garrido, A:
Univ Autonoma Barcelona, Hosp Santa Creu & St Pau, E-08193 Barcelona, Spain
Moreno, ME:
Univ Autonoma Barcelona, Hosp Santa Creu & St Pau, E-08193 Barcelona, Spain
Granell, M:
Univ Autonoma Barcelona, Hosp Santa Creu & St Pau, E-08193 Barcelona, Spain
Moreno, C:
Univ Autonoma Barcelona, Hosp Santa Creu & St Pau, E-08193 Barcelona, Spain
Saavedra, S:
Univ Autonoma Barcelona, Hosp Santa Creu & St Pau, E-08193 Barcelona, Spain
Briones, J:
Univ Autonoma Barcelona, Hosp Santa Creu & St Pau, E-08193 Barcelona, Spain
Brunet, S:
Univ Autonoma Barcelona, Hosp Santa Creu & St Pau, E-08193 Barcelona, Spain
Sierra, J:
Univ Autonoma Barcelona, Hosp Santa Creu & St Pau, E-08193 Barcelona, Spain
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