Etanercept for steroid-refractory acute graft-versus-host disease: A single center experience

De Jong, Cornelis N.; Saes, Lotte; Klerk, Clara P. W.; Van der Klift, Marjolein; Cornelissen, Jan J.; Broers, Annoek E. C.

Viral infections were observed in 9 out of 15 patients, with reactivation of CMV in 4 patients and EBV in 3 patients. In one patient a rapid rise in EBV viral load was accompanied by lymphadenopathy and a monoclonal B-cell population in the bone marrow. This EBV-lymphoproliferative disease was successfully treated with rituximab in combination with reduction of immunosuppression. CMV was monitored by PCR in patients at risk and treated pre-emptively with (val)ganciclovir. Nevertheless, one patient developed CMV-related colitis under pre-emptive treatment, probably related to the severe immunosuppressive state of our patients due to the GVHD itself and the immunosuppressive agents used. Episodes of septicemia were observed in 9 patients including four due to Gram-negative bacteria. All episodes of Gramnegative septicemia occurred either before the introduction of levofloxacin or were caused by less susceptible strains.