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.

Acute graft-versus-host disease (aGVHD) is a major cause of morbidity and mortality after alloSCT [1] . High dose systemic glucocorticosteroids (steroids) are currently recommended as first-line treatment for grade II-IV aGVHD resulting in overall complete responses (CR) in 40%-50% of patients [2, 3] . However, the likelihood to respond to treatment decreases with increasing severity of the disease. Patients with grade II aGVHD at diagnosis are significantly more likely to achieve a CR to initial treatment with high dose steroids as compared to patients with more advanced aGVHD [4, 5] . The prognosis of patients with aGVHD who fail to respond to high dose steroids is poor [2] . Currently there is no standard second-line treatment for steroid-refractory aGVHD (SR-aGVHD). Numerous strategies to treat SR-aGVHD have been reported, but results have been disappointing with varying response rates and long term overall survival (OS) of only 20-30% [2] .