title: Tocilizumab for steroid refractory acute graft-versus-host disease.
abstract: Acute graft-versus-host-disease (aGVHD) is a frequent and often lethal complication of allogeneic hematopoietic stem cell transplant despite prophylaxis. Tocilizumab is a humanized anti-IL-6 receptor monoclonal antibody that has evidence of activity in patients with steroid refractory (SR) GVHD. We retrospectively report on nine patients with grade 3 or 4 SR aGVHD who received tocilizumab. Eight mg/kg of tocilizumab was administered intravenously every 3-4 weeks. aGVHD grading and responses were based on consensus criteria. Median age at transplant was 48 years. Five patients had alternate donor sources. Median time from aGVHD onset to tocilizumab administration was 44 days. Two patients had complete responses and two had partial responses. Median survival from start of tocilizumab was 26 days (range 13-1054). Our limited experience demonstrated an overall response rate of 44% (CR + PR); however, this response was not durable. Further studies are needed to determine the optimal time for tocilizumab initiation.
authors.affiliation: a Department of Pharmacy , James Cancer Hospital, The Ohio State University Comprehensive Cancer Center , Columbus , Ohio , USA.
authors.forename: Julianna V F
authors.initials: JV
authors.lastname: Roddy
authors.affiliation: b Division of Hematology, Department of Internal Medicine , James Cancer Hospital, The Ohio State University Comprehensive Cancer Center , Columbus , Ohio , USA.
authors.forename: Bradley M
authors.initials: BM
authors.lastname: Haverkos
authors.affiliation: c Department of Pharmacy , University of Arizona Cancer Center , Tucson , AZ , USA.
authors.forename: Ali
authors.initials: A
authors.lastname: McBride
authors.affiliation: b Division of Hematology, Department of Internal Medicine , James Cancer Hospital, The Ohio State University Comprehensive Cancer Center , Columbus , Ohio , USA.
authors.forename: Kathryn M
authors.initials: KM
authors.lastname: Leininger
authors.affiliation: b Division of Hematology, Department of Internal Medicine , James Cancer Hospital, The Ohio State University Comprehensive Cancer Center , Columbus , Ohio , USA.
authors.forename: Samantha
authors.initials: S
authors.lastname: Jaglowski
authors.affiliation: b Division of Hematology, Department of Internal Medicine , James Cancer Hospital, The Ohio State University Comprehensive Cancer Center , Columbus , Ohio , USA.
authors.forename: Sam
authors.initials: S
authors.lastname: Penza
authors.affiliation: b Division of Hematology, Department of Internal Medicine , James Cancer Hospital, The Ohio State University Comprehensive Cancer Center , Columbus , Ohio , USA.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Klisovic
authors.affiliation: b Division of Hematology, Department of Internal Medicine , James Cancer Hospital, The Ohio State University Comprehensive Cancer Center , Columbus , Ohio , USA.
authors.forename: William
authors.initials: W
authors.lastname: Blum
authors.affiliation: b Division of Hematology, Department of Internal Medicine , James Cancer Hospital, The Ohio State University Comprehensive Cancer Center , Columbus , Ohio , USA.
authors.forename: Sumithira
authors.initials: S
authors.lastname: Vasu
authors.affiliation: b Division of Hematology, Department of Internal Medicine , James Cancer Hospital, The Ohio State University Comprehensive Cancer Center , Columbus , Ohio , USA.
authors.forename: Craig C
authors.initials: CC
authors.lastname: Hofmeister
authors.affiliation: b Division of Hematology, Department of Internal Medicine , James Cancer Hospital, The Ohio State University Comprehensive Cancer Center , Columbus , Ohio , USA.
authors.forename: Don M
authors.initials: DM
authors.lastname: Benson
authors.affiliation: b Division of Hematology, Department of Internal Medicine , James Cancer Hospital, The Ohio State University Comprehensive Cancer Center , Columbus , Ohio , USA.
authors.forename: Leslie A
authors.initials: LA
authors.lastname: Andritsos
authors.affiliation: b Division of Hematology, Department of Internal Medicine , James Cancer Hospital, The Ohio State University Comprehensive Cancer Center , Columbus , Ohio , USA.
authors.forename: Steven M
authors.initials: SM
authors.lastname: Devine
authors.affiliation: b Division of Hematology, Department of Internal Medicine , James Cancer Hospital, The Ohio State University Comprehensive Cancer Center , Columbus , Ohio , USA.
authors.forename: Yvonne A
authors.initials: YA
authors.lastname: Efebera
mesh_terms: D000328:Adult; D061067:Antibodies, Monoclonal, Humanized / Q000494:pharmacology / Q000627:therapeutic use*; D004351:Drug Resistance; D005260:Female; D006086:Graft vs Host Disease / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology*; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007239:Infections / Q000175:diagnosis / Q000209:etiology; D008297:Male; D008875:Middle Aged; D019947:Receptors, Interleukin-6 / Q000037:antagonists & inhibitors; D013256:Steroids / Q000627:therapeutic use; D019172:Transplantation Conditioning; D014184:Transplantation, Homologous; D016896:Treatment Outcome
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D019947:Receptors, Interleukin-6; D013256:Steroids; C502936:tocilizumab
keywords: Antibody-based immunotherapy; clinical results; cytokine and chemokine biology; graft-versus-host disease