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Etanercept for steroid-refractory acute graft versus host disease following allogeneic hematopoietic stem cell transplantation

The Korean Journal of Internal Medicine 2014년 29권 5호 p.630 ~ p.636

박주한(Park Joo-Han) - Ajou University School of Medicine Department of Hematology-Oncology
이효정(Lee Hyo-Jung) - Ajou University School of Medicine Department of Hematology-Oncology
김세란(Kim Sei-Rhan) - Ajou University School of Medicine Department of Hematology-Oncology
송가원(Song Ga-Won) - Ajou University School of Medicine Department of Hematology-Oncology
(Lee Seung-Kyong) - Ajou University School of Medicine Department of Hematology-Oncology
박선영(Park Sun-Young) - Ajou University School of Medicine Department of Hematology-Oncology
김기찬(Kim Ki-Chan) - Ajou University School of Medicine Department of Hematology-Oncology
황선혁(Hwang Sun-Hyuk) - Ajou University School of Medicine Department of Hematology-Oncology
박준성(Park Joon-Seong) - Ajou University School of Medicine Department of Hematology-Oncology

Abstract

Background/Aims: The treatment for steroid-refractory acute graft versus host disease (GVHD) after allogeneic stem cell transplantation (allo-SCT) needs to be standardized. We report our clinical experience with etanercept for steroid-refractory acute GVHD.

Methods: Eighteen patients who underwent allo-SCT and presented with steroid-refractory acute GVHD at Ajou University Hospital were studied retrospectively. They were given 25 mg of etanercept subcutaneously twice weekly for 4 weeks. The clinical responses were evaluated with regard to the severity of acute GVHD.

Results: The median patient age was 43.5 years. Using nonparametric tests, etanercept had a down-grading effect on acute GVHD (p = 0.005), although no patient experienced complete remission. Partial responses were seen in 80%, 17%, and 57% of grade II to IV patients, respectively. Skin and gut GVHD were well controlled with etanercept, whereas hepatic GVHD was not. Four patients died of fatal infections. No factors affecting the clinical outcome of etanercept were identified.

Conclusions: Etanercept has a modest effect on steroid-refractory acute GVHD after allo-SCT, with tolerable side effects.