Treatment of aGVHD with OKT3: clinical outcome and side-effects associated with release of TNF alpha.
Monoclonal antibodies are increasingly used for treatment of acute graft-versus-host disease (aGVHD) in bone marrow transplantation. We treated seven patients with steroid resistant aGVHD with the monoclonal anti-T cell antibody OKT3. Though five patients showed improvement of aGVHD, only two became long-term survivors. OKT3 treatment was accompanied by deterioration of microangiopathy and prolonged increase of tumor-necrosis-factor alpha serum levels indicating activation of monocytes/macrophages in vivo, as this was not observed in a control group of patients receiving anti-T cell globulin. These findings may be related to immunostimulatory activity reported for OKT3 in vitro. Strategies interfering with cytokine release should improve clinical results of OKT3 treatment.
Medizinische Klinik III, Universität München, Germany.
B
B
Gleixner
H J
HJ
Kolb
E
E
Holler
S
S
Liesenfeld
C
C
Riedner
E
E
Hiller
C
C
Seeber
J
J
Kempeni
A
A
Möller
H
H
Knabe
D000208:Acute Disease; D000328:Adult; D016026:Bone Marrow Transplantation / Q000009:adverse effects* / Q000276:immunology; D005260:Female; D006086:Graft vs Host Disease / Q000276:immunology / Q000517:prevention & control / Q000628:therapy*; D006801:Humans; D007074:Immunoglobulin G / Q000096:biosynthesis; D066298:In Vitro Techniques; D008213:Lymphocyte Activation; D008297:Male; D016853:Muromonab-CD3 / Q000009:adverse effects / Q000627:therapeutic use*; D014409:Tumor Necrosis Factor-alpha / Q000378:metabolism*
D007074:Immunoglobulin G; D016853:Muromonab-CD3; D014409:Tumor Necrosis Factor-alpha