Acemtra for GVHD – pro
Corticosteroid refractory graft-versus-host disease (GVHD) is one of the major challenges in the management of allogeneic stem cell transplant recipients. Although numerous agents have been employed to treat this patient population, no standardized second-line therapy exists. In this study, we report our experience with the administration of tocilizumab, an anti-interleukin 6 receptor antibody, in the treatment of steroid refractory GVHD. Tocilizumab was administered to 8 patients with refractory acute (n = 6) or chronic GVHD (cGVHD) (n = 2) once every 3 to 4 weeks. The majority of patients with acute GVHD (aGVHD) had grade IV organ involvement of the skin or gastrointestinal tract, whereas both patients with cGVHD had long-standing severe skin sclerosis at the time of treatment. There were no allergic or infusion-related adverse events. Treatment was discontinued in one patient due to safety concerns. This drug is a member of a class of biologic DMARDs designed to neutralize inflammatory cytokines that target specific pathways of the immune system and either enhance or inhibit immune response. Drugs in this class with an FDA-approved indication for the treatment of adults with moderately to severely active RA include adalimumab (Humira®, Abbott Laboratories, North Chicago, IL), certolizumab pegol (Cimzia®, UCB, Inc., Smyrna, GA), etanercept (Enbrel®, Immunex Corporation, Thousand Oaks, CA), golimumab (Simponi® and Simponi Aria®, Janssen Biotech Inc., Horsham, PA), and infliximab (Remicade®, Janssen Biotech Inc., Horsham, PA). It had a black box warning for infection and should not be used indiscriminately.
Usama Gergis, Jon Arnason, Rhonda Yantiss, Tsiporah Shore, Usama Wissa and Eric Feldman
Weill Cornell Medical College, New York, NY. Effectiveness and Safety of Tocilizumab, an Anti–Interleukin-6 Receptor Monoclonal Antibody, in a Patient With Refractory GI Graft-Versus-Host Disease. Published online before print August 16, 2010, doi: 10.1200/JCO.2010.29.1682
JCO October 20, 2010 vol. 28 no. 30 e602-e604
W.R. Dobryski et al, Tocilizumab for the treatment of steroid refractory graft-versus-host disease.
Biol Blood Marrow Transplant. 2011 Dec;17(12):1862-8. doi: 10.1016/j.bbmt.2011.07.001. Epub 2011 Jul 13.