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.

The characteristics of all fifteen patients treated with etanercept for SR-aGVHD are shown in Table 1 . Median age was 54 years (range 22-65 years), eleven patients (73%) were male. One patient received a myeloablative conditioning (MA) regimen consisting of cyclophosphamide (2 x 60 mg/kg) and 2 x 6 Gray (Gy) total body irradiation (TBI). All other patients either received a reduced intensity conditioning (RIC) with cyclophosphamide (1 x 60 mg/kg), fludarabin (4 x 40 mg/m2) and TBI (2 x 2 Gy) or a non-myeloablative conditioning (NMA) with fludarabin (3 x 30 mg/m2) and TBI (1 x 2 Gy). Eleven patients received peripheral blood stem cells either from HLA identical sibling donors (n = 3) or from HLA matched unrelated donors (n = 8). Four patients received cord blood (CB) derived stem cells. One patient developed late-onset aGVHD after discontinuation of immunosuppressants, at day 393 post-transplant. All other patients were on GVHD prophylaxis at the onset of aGVHD. Acute GVHD developed at a median of 61 days after transplantation (range 23-393 days). All patients had grade III GVHD of the gut, the majority had involvement of a second organ. First-line treatment consisted of CsA and prednisolone 2/mg/kg/day in fourteen patients; one patient was treated with high dose steroids combined with MMF, because impaired renal function prohibited the use of calcineurin inhibitors.