Graft-versus-host disease (GVHD) is an illness that appears in pa tients after allogeneic bone marrow transplantation. Acute disease usually manifests in the first one or two months after transplantation. It targets epidermal cells in the skin, liver, and gastrointestinal tract. It is graded I through IV on the basis of the severity of the disease. Chronic GVHD usually occurs more than three months after allogeneic bone marrow transplantation. It is graded on the basis of the extent, rather than severity, of the disease.
Infliximab is a chimeric human-murine monoclonal antibody to TNF-. It binds to both soluble and transmembrane human TNF- and inhibits binding to TNF- receptors. Infliximab is currently indicated for the treatment of immunologic-based diseases (rheumatoid arthritis, moderately to severely active Crohn’s disease, and fistulizing Crohn’s disease), assuming patients have had inadequate responses to conventional therapy. It is not approved for the treatment of GVHD. There are case reports of its use for GVHD. Remicade has also been reported to cause GVHD. The 2012 guideline by Dignan et al in British Journal of Hematology does not recommend infliximab in second line (after failure of steroids) .
Dignan FL, Amrolia P, Clark A, Cornish J, Jackson G, Mahendra P, Scarisbrick JJ, Taylor PC, Shaw BE, Potter MN, on behalf of the Haemato-oncology Task Force of the British Committee [trunc]. Diagnosis and management of chronic graft-versus-host disease. Br J Haematol. 2012 Jul;158(1):46-61. [125 references]
Uptodate, Treatment of chronic graft-versus-host disease, 2015
Alousi AM, Weisdorf DJ, Logan BR, Bolaños-Meade J, Carter S, Difronzo N, et al. Etanercept, mycophenolate, denileukin, or pentostatin plus corticosteroids for acute graft-versus-host disease: a randomized phase 2 trial from the Blood and Marrow Transplant Clinical Trials Network. Blood. Jul 16 2009;114(3):511-7.
A phase I study has been completed: GVH 022P: Study Using Anti Tumor Necrosis Factor Antibody (Infliximab) for Treatment of Acute Graft Versus Host Disease
This study has been completed, NCT00228839. The major purpose of this study is to evaluate the way the body uses and absorbs (the pharmacokinetic profile) a drug called anti tumor necrosis factor antibody (infliximab) for the treatment of acute GVHD.
G Kobbe et al, Treatment of severe steroid refractory acute graft-versus-host disease with infliximab, a chimeric human/mouse antiTNF antibody July (1) 2001, Volume 28, Number 1, Pages 47-49
Marshall J, Blackhouse G, Goeree R, et al. Infliximab for the treatment of Crohn’s disease: a systematic review and cost-utility analysis. Technology Report No. 24. Ottawa, ON: Canadian Coordinating Office for Health Technology Assessment (CCOHTA); 2002.