Recombinant human tumor necrosis factor receptor fusion protein as complementary treatment for chronic graft-versus-host disease.
BACKGROUND
Chronic graft-versus-host disease (cGVHD) remains one of the major late complications in allogeneic bone marrow transplantation (BMT). Prolonged immunosuppression often results in significant morbidity and mortality. Cytokine dysregulation is implicated in the pathophysiology of cGVHD, and tumor necrosis factor-alpha (TNF-alpha) plays a central role.


METHODS
Recombinant soluble TNF receptor (Enbrel) was explored for the use of steroid-dependent cGVHD in 10 patients. Enbrel was given as a subcutaneous injection twice weekly for 4 weeks followed by once weekly for 4 more weeks. Progression or regression of cGVHD was monitored closely by regular clinical follow-up.


RESULTS
Eight patients finished the 8-week treatment course without adverse side effect. Seven of them showed improvement (subjectively and/or objectively) in cGVHD. Steroid taper was initiated as early as 1 month.


CONCLUSIONS
This preliminary encouraging result merits additional studies to optimize Enbrel as a potential complementary therapy for resolution of steroid-dependent cGVHD.
Chiang
Kuang-Yueh
KY
Division of Transplantation Medicine, Palmetto Richland Memorial Hospital South Carolina Cancer Center, Columbia, South Carolina 29203, USA. kuang-yueh.chiang@choa.org.
Abhyankar
Sunil
S
Bridges
Kerry
K
Godder
Kamar
K
Henslee-Downey
Jean P
JP
D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D016026:Bone Marrow Transplantation / Q000276:immunology*; D002908:Chronic Disease; D000068800:Etanercept; D006086:Graft vs Host Disease / Q000188:drug therapy*; D006801:Humans; D007074:Immunoglobulin G / Q000627:therapeutic use*; D018124:Receptors, Tumor Necrosis Factor / Q000627:therapeutic use*; D011993:Recombinant Fusion Proteins / Q000627:therapeutic use; D014184:Transplantation, Homologous
D000894:Anti-Inflammatory Agents, Non-Steroidal; D007074:Immunoglobulin G; D018124:Receptors, Tumor Necrosis Factor; D011993:Recombinant Fusion Proteins; D000068800:Etanercept