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Infliximab for steroid refractory or dependent gastrointestinal acute graft‐versus‐host disease in children after allogeneic hematopoietic stem cell transplantation
Author(s) -
Yang Jun,
Cheuk Daniel Ka Leung,
Ha Shau Yin,
Chiang Alan Kwok Shing,
Lee Tsz Leung,
Ho Marco Hok Kung,
Chan Godfrey Chi Fung
Publication year - 2012
Publication title -
pediatric transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.457
H-Index - 69
eISSN - 1399-3046
pISSN - 1397-3142
DOI - 10.1111/j.1399-3046.2012.01756.x
Subject(s) - medicine , infliximab , gastroenterology , hematopoietic stem cell transplantation , graft versus host disease , transplantation , refractory (planetary science) , adverse effect , surgery , disease , physics , astrobiology
Yang J, Cheuk DKL, Ha SY, Chiang AKS, Lee TL, Ho MHK, Chan GCF. Infliximab for steroid refractory or dependent gastrointestinal acute graft‐versus‐host disease in children after allogeneic hematopoietic stem cell transplantation. Abstract: aGVHD of the GI tract is common after allogeneic HSCT. Corticosteroids are the mainstay of treatment. Recent data suggest infliximab might be beneficial for steroid refractory aGVHD. We reviewed our experience in 10 pediatric patients who developed severe steroid refractory aGVHD (stage 3, n = 6; stage 4, n = 4), after an allogeneic matched unrelated HSCT for various hematological diseases (leukemia, n = 7; thalassemia, n = 3). The median age was 9.5 yr (range, 0.8–18.5 yr). All patients received 10 mg/kg infliximab weekly for 3–4 doses. Eight patients had CR and two had partial response. None of the patients developed therapy‐related adverse effects. All patients developed infections subsequently, which may or may not be related to infliximab. Five patients developed chronic GVHD (cGVHD) (four severe, one mild). Six patients died at 66–1451 days post‐transplant, from infection (n = 3), aGVHD (n = 1), lung cGVHD (n = 1), or idiopathic pneumonia (n = 1). Four patients were alive at 238–924 days post‐transplant, all of whom had an increase in BMI by six months post‐transplant. In conclusion, infliximab is well tolerated and appears effective in children with steroid refractory or dependent GI aGVHD. Infection is common and mortality remains high.