title: The successful use of alemtuzumab for treatment of steroid-refractory acute graft-versus-host disease in pediatric patients.
abstract: SR-aGVHD remains a significant cause of morbidity and mortality in allogeneic HCT recipients. Alemtuzumab has been used with success in adult patients but has not been studied in the pediatric setting. To estimate the effectiveness of alemtuzumab for the treatment of SR-aGVHD in pediatric patients, we retrospectively reviewed the charts of 19 patients (median age 4 yr, range 0.5-28 years) with grades II (n = 3), III (n = 10), or IV (n = 6) SR-aGVHD who received alemtuzumab treatment. Patients received a median dose of 0.9 mg/kg alemtuzumab (range 0.3-2 mg/kg) divided over 2-6 days. Eighty-nine percent of patients received additional courses. A complete response, defined as GVHD of grade 0 at four wk following the first alemtuzumab course, was observed in nine patients (47%). A partial response, defined as an improvement in grade after four wk, was observed in five patients (26%). There was no response in five patients (26%). The overall response rate at four wk was 73%. Infectious complications included bacteremia (47%), presumed or documented fungal infections (21%), adenovirus viremia (52%), EBV viremia (36%), and CMV viremia (36%). We conclude that alemtuzumab is effective for SR-aGVHD in pediatric patients with a tolerable spectrum of complications.
authors.affiliation: Division of Bone Marrow Transplantation and Immune Deficiency, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital, Cincinnati, OH, USA.
authors.forename: Pooja
authors.initials: P
authors.lastname: Khandelwal
authors.forename: Julia
authors.initials: J
authors.lastname: Lawrence
authors.forename: Alexandra H
authors.initials: AH
authors.lastname: Filipovich
authors.forename: Stella M
authors.initials: SM
authors.lastname: Davies
authors.forename: Jacob J
authors.initials: JJ
authors.lastname: Bleesing
authors.forename: Michael B
authors.initials: MB
authors.lastname: Jordan
authors.forename: Parinda
authors.initials: P
authors.lastname: Mehta
authors.forename: Sonata
authors.initials: S
authors.lastname: Jodele
authors.forename: Michael S
authors.initials: MS
authors.lastname: Grimley
authors.forename: Ashish
authors.initials: A
authors.lastname: Kumar
authors.forename: Kasiani
authors.initials: K
authors.lastname: Myers
authors.forename: Rebecca A
authors.initials: RA
authors.lastname: Marsh
mesh_terms: D000257:Adenoviridae Infections / Q000188:drug therapy; D000293:Adolescent; D000328:Adult; D000074323:Alemtuzumab; D000465:Algorithms; D000890:Anti-Infective Agents / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000188:drug therapy; D002648:Child; D002675:Child, Preschool; D003586:Cytomegalovirus Infections / Q000188:drug therapy; D004351:Drug Resistance; D020031:Epstein-Barr Virus Infections / Q000188:drug therapy; D006086:Graft vs Host Disease / Q000188:drug therapy*; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007223:Infant; D009181:Mycoses / Q000188:drug therapy; D012008:Recurrence; D012189:Retrospective Studies; D013256:Steroids / Q000627:therapeutic use*; D016896:Treatment Outcome; D014777:Virus Diseases / Q000188:drug therapy; D055815:Young Adult
chemical_list: D000890:Anti-Infective Agents; D061067:Antibodies, Monoclonal, Humanized; D013256:Steroids; D000074323:Alemtuzumab
keywords: Campath; alemtuzumab; graft-versus-host disease; steroid-refractory acute graft-versus-host disease