[Anti-CD25 monoclonal antibody with antithymocytic globulin for steroid-resistant severe acute graft-versus-host disease after unrelated donor hematopoietic stem cell transplantation]

Nan Fang Yi Ke Da Xue Xue Bao. 2008 Dec;28(12):2224-6.
[Article in Chinese]

Abstract

Objective: To study the effect of anti-CD25 monoclonal antibody (mAb) combined with antithymocytic globulin (ATG) in the treatment of severe steroid-resistant acute graft-versus-host disease (aGVHD) after unrelated donor hematopoietic stem cell transplantation (UD-HSCT).

Methods: Ten leukemic patients who developed severe steroid-resistant aGVHD during UD-HSCT received a standard dose of anti-CD25 mAb and a medium or low dose of ATG. The effect on aGVHD control, patients' survival, infection and relapse after the therapy were analyzed.

Results: Eight of the 10 patients had complete remission and 2 had partial remission after the combined therapy. In the 8 patients with complete remission, 2 developed third degree aGVHD 3-3.5 months after the transplantation, and were managed with a second combined therapy to successfully achieve complete remission. In the total of 12 combined treatments, the median time of therapeutic effect was 5 days (3-10 days); the median complete relief time was 12 days (8-30 days) in the 10 cases. Among the 8 patients who survived for more than 3 months, 7 were diagnosed to have chronic GVHD including 4 with extensive chronic GVHD. No relapse of leukemia was found in these patients. Five patients survived the 2-year-long follow-up after the transplantation with survival time over 2 years; of the 5 patients who died within 2 years after the transplantation, 1 survived for more than one year, and 4 for less than 6 months. Two patients died from invasive fungal infection, two from aGVHD and one from cGVHD-induced multiple organ failure.

Conclusion: Anti-CD25 mAb combined with ATG has good therapeutic effect on steroid-resistant sever aGVHD and may help achieve high complete remission rate and long-term survival in leukemic patients after UD-HSCT.

Publication types

  • English Abstract

MeSH terms

  • Acute Disease
  • Adult
  • Antibodies, Monoclonal / administration & dosage
  • Antibodies, Monoclonal / therapeutic use*
  • Antilymphocyte Serum / administration & dosage
  • Antilymphocyte Serum / therapeutic use*
  • Drug Resistance
  • Drug Therapy, Combination
  • Female
  • Graft vs Host Disease / drug therapy*
  • Graft vs Host Disease / prevention & control
  • Hematopoietic Stem Cell Transplantation / adverse effects*
  • Humans
  • Interleukin-2 Receptor alpha Subunit / immunology*
  • Male
  • Prednisone / therapeutic use
  • Young Adult

Substances

  • Antibodies, Monoclonal
  • Antilymphocyte Serum
  • Interleukin-2 Receptor alpha Subunit
  • Prednisone