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.
Gleixner
B
B
Medizinische Klinik III, Universität München, Germany.
Kolb
H J
HJ
Holler
E
E
Liesenfeld
S
S
Riedner
C
C
Hiller
E
E
Seeber
C
C
Kempeni
J
J
Möller
A
A
Knabe
H
H
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