title: Alemtuzumab for severe steroid-refractory gastrointestinal acute graft-versus-host disease.
abstract: Acute graft-versus-host disease (aGVHD) still remains the main cause of morbidity and mortality after allogeneic stem cell transplantation. Moreover, patients who did not respond to first-line treatment with glucocorticosteroids have a very poor outcome. Some studies suggested that alemtuzumab (a humanized monoclonal antibody against the CD52 antigen) might be effective for treatment of refractory aGVHD. Here we report a single-center experience with alemtuzumab in refractory gastrointestinal aGVHD. From September 2009 to April 2012 at the Grenoble medical university center, 24 patients who had presented a refractory gastrointestinal aGVHD to corticosteroid, or after another immunosuppressive drug, were retrospectively analyzed. Most patients (n = 19) presented stage 4 gastrointestinal aGVHD. Response to treatment (either complete or partial) was observed in 15 patients (62.4%). The overall survival rate at 1 year for all patients was 33.3% (95% confidence interval [CI], 15.9% to 51.9%) and for responders, 53.3% (95% CI, 26.3% to 74.4%). Two patients died from infection, 5 patients from recurrent GVHD, and 1 from an uncontrolled post-transplant lymphoproliferative disorder.
authors.affiliation: Clinique d'hématologie, CHU de Grenoble, UMR 5525 CNRS-UJF, France. Electronic address: mmeunier2@chu-grenoble.fr.
authors.forename: Mathieu
authors.initials: M
authors.lastname: Meunier
authors.affiliation: Clinique d'hématologie, CHU de Grenoble, UMR 5525 CNRS-UJF, France.
authors.forename: Claude Eric
authors.initials: CE
authors.lastname: Bulabois
authors.affiliation: Clinique d'hématologie, CHU de Grenoble, UMR 5525 CNRS-UJF, France.
authors.forename: Anne
authors.initials: A
authors.lastname: Thiebaut-Bertrand
authors.affiliation: Service d'hématologie-greffe, Hôpital Saint-Louis, Assistance Publique, hôpitaux de Paris, Université Paris, France.
authors.forename: Raphaël
authors.initials: R
authors.lastname: Itzykson
authors.affiliation: Clinique d'hématologie, CHU de Grenoble, UMR 5525 CNRS-UJF, France.
authors.forename: Martin
authors.initials: M
authors.lastname: Carre
authors.affiliation: Clinique d'hématologie, CHU de Grenoble, UMR 5525 CNRS-UJF, France.
authors.forename: Sylvain
authors.initials: S
authors.lastname: Carras
authors.affiliation: Clinique d'hématologie, CHU de Grenoble, UMR 5525 CNRS-UJF, France; Etablissement français du sang, CHU de Grenoble, UMR 5525 CNRS-UJF, France.
authors.forename: Fréderic
authors.initials: F
authors.lastname: Garban
authors.affiliation: Clinique d'hématologie, CHU de Grenoble, UMR 5525 CNRS-UJF, France.
authors.forename: Jean Yves
authors.initials: JY
authors.lastname: Cahn
mesh_terms: D000328:Adult; D000074323:Alemtuzumab; D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage / Q000627:therapeutic use*; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D006086:Graft vs Host Disease / Q000188:drug therapy* / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D055815:Young Adult
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D000970:Antineoplastic Agents; D000074323:Alemtuzumab
keywords: Acute graft-versus-host disease; Alemtuzumab; Allogeneic hematopoietic cell transplantation; Antibody therapy