Synapse - Long-term follow-up of patients treated with daclizumab for steroid-refractory acute graft-vs-host disease

Long-term follow-up of patients treated with daclizumab for steroid-refractory acute graft-vs-host disease Journal Article

Authors:	Perales, M. A.; Ishill, N.; Lomazow, W. A.; Weinstock, D. M.; Papadopoulos, E. B.; Dastigir, H.; Chiu, M.; Boulad, F.; Castro-Malaspina, H. R.; Heller, G.; Jakubowski, A. A.; O'Reilly, R. J.; Small, T. N.; Young, J. W.; Kernan, N. A.
Article Title:	Long-term follow-up of patients treated with daclizumab for steroid-refractory acute graft-vs-host disease
Abstract:	Daclizumab has been shown to have activity in acute GVHD, but appears to be associated with an increased risk of infection. To investigate further the long-term effects of daclizumab, we performed a retrospective review of 57 patients who underwent an allogeneic hematopoietic stem cell transplant from January 1993 through June 2000 and were treated with daclizumab for steroid-refractory acute GVHD. The median number of daclizumab doses given was 5 (range 1-22). GVHD was assessed at baseline, days 15, 29 and 43. By day 43, 54% patients had an improvement in their overall GVHD score, including 76% patients aged ≤18. Opportunistic infections developed in 95% patients. Forty-three patients (75%) died following treatment with daclizumab. The causes of death included active GVHD and infection (79%), active GVHD (5%), chronic GVHD (2%) and relapse (14%). Patients with grade 3-4 GVHD had a significantly shorter median survival than patients with grade 1-2 GVHD (2.0 vs 5.1 months, P=0.001). Daclizumab has no infusion-related toxicity, is active in steroid-refractory GVHD, especially among pediatric patients, but is associated with significant morbidity and mortality due to infectious complications. Careful patient selection and aggressive prophylaxis against viral and fungal infections are recommended.
Keywords:	adolescent; adult; cancer survival; child; child, preschool; middle aged; leukemia; retrospective studies; transplantation, homologous; major clinical study; busulfan; review; unspecified side effect; methotrexate; follow up; follow-up studies; morbidity; steroid; hematopoietic stem cell transplantation; drug resistance; retrospective study; cancer mortality; cause of death; antibodies, monoclonal; acute graft versus host disease; chronic graft versus host disease; myelodysplastic syndrome; death; immunoglobulin g; infant; lymphoma; scoring system; long term care; allogeneic hematopoietic stem cell transplantation; cancer relapse; methylprednisolone; virus infection; graft vs host disease; mycosis; cyclosporin; acute disease; opportunistic infections; thymocyte antibody; aplastic anemia; opportunistic infection; steroids; drug evaluation; daclizumab
Journal Title:	Bone Marrow Transplantation
Volume:	40
Issue:	5
ISSN:	0268-3369
Publisher:	Nature Publishing Group
Date Published:	2007-09-01
Start Page:	481
End Page:	486
Language:	English
DOI:	10.1038/sj.bmt.1705762
PUBMED:	17618322
PROVIDER:	scopus
DOI/URL:	http://www.scopus.com/inward/record.url?eid=2-s2.0-34548062133&partnerID=40&md5=de0e758581cf140b5bba6a47bd417f15
Notes:	--- - "Cited By (since 1996): 22" - "Export Date: 17 November 2011" - "CODEN: BMTRE" - "Source: Scopus"