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.

In our study, invasive aspergillosis was the cause of death in 50% of patients that died of an infection. Susceptibility to aspergillus is known to be strongly increased by GVHD and immunosuppressive therapy [17] . Adequate prophylaxis by hospitalizing SR-aGVHD patients in high-efficiency particulate arrestance (HEPA)-filtered rooms if necessary and treatment with anti-fungal medication for the duration of immunosuppressive therapy is warranted. In the present study, all but one patient received antifungal prophylaxis at the time of initiation of etanercept. Thirteen patients received voriconazole and one patient was treated with amphotericin inhalations as elevated liver enzymes impeded the use of voriconazole. Despite prophylaxis, three patients developed invasive mould infections. The first patient developed an invasive aspergillosis despite amphotericin inhalations. The second patient proved to have a voriconazole-resistant aspergillus, and the third patient developed a double infection of voriconazole-resistant aspergillosis and zygomycosis.