title: Etanercept for steroid-refractory acute graft versus host disease following allogeneic hematopoietic stem cell transplantation.
abstract: OBJECTIVE
  The treatment for steroid-refractory acute graft versus host disease (GVHD) after allogeneic stem cell transplantation (allo-SCT) needs to be standardized. We report our clinical experience with etanercept for steroid-refractory acute GVHD.
  
  
  METHODS
  Eighteen patients who underwent allo-SCT and presented with steroid-refractory acute GVHD at Ajou University Hospital were studied retrospectively. They were given 25 mg of etanercept subcutaneously twice weekly for 4 weeks. The clinical responses were evaluated with regard to the severity of acute GVHD.
  
  
  RESULTS
  The median patient age was 43.5 years. Using nonparametric tests, etanercept had a down-grading effect on acute GVHD (p = 0.005), although no patient experienced complete remission. Partial responses were seen in 80%, 17%, and 57% of grade II to IV patients, respectively. Skin and gut GVHD were well controlled with etanercept, whereas hepatic GVHD was not. Four patients died of fatal infections. No factors affecting the clinical outcome of etanercept were identified.
  
  
  CONCLUSIONS
  Etanercept has a modest effect on steroid-refractory acute GVHD after allo-SCT, with tolerable side effects.
authors.affiliation: Department of Hematology and Oncology, Ajou University School of Medicine, Suwon, Korea.
authors.forename: Joo Han
authors.initials: JH
authors.lastname: Park
authors.affiliation: Department of Hematology and Oncology, Ajou University School of Medicine, Suwon, Korea.
authors.forename: Hyo Jung
authors.initials: HJ
authors.lastname: Lee
authors.affiliation: Department of Hematology and Oncology, Ajou University School of Medicine, Suwon, Korea.
authors.forename: Sei Rhan
authors.initials: SR
authors.lastname: Kim
authors.affiliation: Department of Hematology and Oncology, Ajou University School of Medicine, Suwon, Korea.
authors.forename: Ga Won
authors.initials: GW
authors.lastname: Song
authors.affiliation: Department of Hematology and Oncology, Ajou University School of Medicine, Suwon, Korea.
authors.forename: Seung Kyong
authors.initials: SK
authors.lastname: Lee
authors.affiliation: Department of Hematology and Oncology, Ajou University School of Medicine, Suwon, Korea.
authors.forename: Sun Young
authors.initials: SY
authors.lastname: Park
authors.affiliation: Department of Hematology and Oncology, Ajou University School of Medicine, Suwon, Korea.
authors.forename: Ki Chan
authors.initials: KC
authors.lastname: Kim
authors.affiliation: Department of Hematology and Oncology, Ajou University School of Medicine, Suwon, Korea.
authors.forename: Sun Hyuk
authors.initials: SH
authors.lastname: Hwang
authors.affiliation: Department of Hematology and Oncology, Ajou University School of Medicine, Suwon, Korea.
authors.forename: Joon Seong
authors.initials: JS
authors.lastname: Park
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D064591:Allografts; D000068800:Etanercept; D005260:Female; D006086:Graft vs Host Disease / Q000209:etiology / Q000628:therapy*; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D007074:Immunoglobulin G / Q000009:adverse effects / Q000627:therapeutic use*; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D018124:Receptors, Tumor Necrosis Factor / Q000627:therapeutic use*; D012189:Retrospective Studies; D013256:Steroids / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D007074:Immunoglobulin G; D007166:Immunosuppressive Agents; D018124:Receptors, Tumor Necrosis Factor; D013256:Steroids; D000068800:Etanercept
keywords: Graft vs host disease; Stem cell transplantation; TNFR-Fc fusion protein