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.

Tumor necrosis factor alpha (TNFα) is involved in the pathophysiology of aGVHD by activating antigen-presenting cells, recruiting effector cells and causing tissue damage [6] . Etanercept is a recombinant human tumor necrosis receptor fusion protein which binds TNFα with high affinity and as a consequence inhibits the biological activity of TNFα. Studies that have investigated the use of anti-TNFα as primary as well as secondary treatment in aGVHD have shown promising response rates. First-line combination with methylprednisolone yielded a CR rate of 69% [7] and second-line treatment resulted in an overall response rate (ORR) of 46% [8] . Second-line therapy combining etanercept with daclizumab showed an ORR of 67% [9] . Treatment with multi-agent combination therapy including etanercept has been reported to induce responses in 81% of patients [10] . Based on these data we implemented the use of etanercept as second-line treatment for SR-aGVHD. Here we report the results of a retrospective analysis of patients with SR-aGVHD treated with etanercept in our center.