title: Limited benefit of pentostatin salvage therapy for steroid-refractory grade III-IV acute graft-versus-host disease.
abstract: Corticosteroid-refractory (SR) acute graft-versus-host disease (aGVHD) remains a major cause of morbidity and mortality after allogeneic hematopoietic cell transplantation. Multiple agents have been evaluated in this setting, but the benefit of pentostatin has not been described well. We report a single-center experience of pentostatin salvage therapy for SR aGVHD. Fifteen patients received pentostatin for SR aGVHD from March 2005 till March 2010 after failure to respond to methylprednisolone ≥ 2 mg/kg/d for at least seven d. All patients had grade III-IV aGVHD prior to pentostatin therapy. Thirteen (87%), 10 (67%), and six (40%) patients had gastrointestinal (GI), skin, and liver involvement of aGVHD, respectively. Pentostatin was given at a median of 33 d after steroid therapy initiation. The dose of pentostatin was 1.4 mg/m(2) daily for three d, repeated every two wk. Eight (53%) patients also received additional therapies. Complete responses were noted in two patients (both in skin). However, one patient relapsed and did not respond to additional salvage treatment. Partial responses were seen in three patients. Fourteen died of GVHD-related causes. This study suggested that pentostatin is of limited benefit in the treatment for SR grade III-IV aGVHD.
authors.affiliation: Allogeneic Blood and Marrow Transplant Program, Princess Margaret Hospital, University of Toronto, Toronto, ON, Canada.
authors.forename: Naheed
authors.initials: N
authors.lastname: Alam
authors.forename: Eshetu G
authors.initials: EG
authors.lastname: Atenafu
authors.forename: Garwin
authors.initials: G
authors.lastname: Tse
authors.forename: Auro
authors.initials: A
authors.lastname: Viswabandya
authors.forename: Vikas
authors.initials: V
authors.lastname: Gupta
authors.forename: Dennis
authors.initials: D
authors.lastname: Kim
authors.forename: Jeffrey H
authors.initials: JH
authors.lastname: Lipton
authors.forename: Hans A
authors.initials: HA
authors.lastname: Messner
authors.forename: John
authors.initials: J
authors.lastname: Kuruvilla
mesh_terms: D000328:Adult; D000368:Aged; D000893:Anti-Inflammatory Agents / Q000009:adverse effects; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D004351:Drug Resistance / Q000187:drug effects*; D005260:Female; D005500:Follow-Up Studies; D006086:Graft vs Host Disease / Q000188:drug therapy* / Q000209:etiology / Q000473:pathology; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007938:Leukemia / Q000628:therapy*; D008297:Male; D008775:Methylprednisolone / Q000009:adverse effects*; D008875:Middle Aged; D015649:Pentostatin / Q000627:therapeutic use*; D011379:Prognosis; D016879:Salvage Therapy; D014184:Transplantation, Homologous; D055815:Young Adult
chemical_list: D000893:Anti-Inflammatory Agents; D000970:Antineoplastic Agents; D015649:Pentostatin; D008775:Methylprednisolone
keywords: graft-versus-host disease; hematopoietic cell transplant; pentostatin