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CP-084 Use of infliximab for steroid-refractory graft-versus-host disease
  1. L Senra Afonso,
  2. A Colón López de Dicastillo,
  3. M Oro Fernández,
  4. D Gómez Gómez,
  5. E Martínez de Ilarduya Bolado,
  6. A Gómez Esteban,
  7. M Martín Vega,
  8. C Abraira Meriel,
  9. M Gómez Martínez,
  10. M Valero Domínguez
  1. Hospital Universitario Marqués de Valdecilla, Hospital Pharmacy, Santander, Spain

Abstract

Background Corticosteroids are the standard care in graft-versus-host disease (GVHD). However, when the condition becomes refractory to steroids, one alternative is the off-label use of Infliximab.

Purpose To evaluate the use of Infliximab in the treatment of Steroid-Refractory GVHD, in a tertiary care hospital.

Material and methods Retrospective observational study of patients with Steroid-Refractory GVHD after stem cell transplantation (SCT), who received infliximab between Jan/2013 and Sep/2014. Data collected from medical records and the electronic prescribing database were: age, gender, underlying disease, SCT characteristics (date, sources of hematopoietic stem cells), GVHD characteristics (start date, stage and affected organs), infliximab dosage, duration of treatment, adverse events (AEs) and clinical results.

Results Five patients (60% men) with an average age of 51.8 years [22–68] were included. The underlying diseases were myelodysplastic syndrome (n = 2), multiple myeloma (n = 1), Hodgkin’s lymphoma (n = 1) or acute myeloid leukaemia (n = 1). Patients underwent bone marrow (n = 4) or peripheral blood (n = 1) HLA-matched allogeneic SCT. In all but one patient stem cells were obtained from unrelated donors. The onset of GVHD was acute in 3 patients and chronic in 2, was classified as stage II (n = 2), III n = 2) or IV (n = 2) and the main organs involved were the gastrointestinal tract (100%) and skin (60%). Infliximab 10 mg/kg/week was administered after failure of corticosteroids and photopheresis. The average number of doses administered was 3.8 [1–6]. 3 patients failed to respond (2 died due to complications of GVHD) while the other two achieved a partial and a complete response. Infliximab intravenous infusion was well tolerated and the most common AEs were infections.

Conclusion Infliximab could be a feasible option for treating Steroid-Refractory GVHD in the opinion of the literature and our findings. Its administration has been shown to be related to an increased risk of infections. Future research with larger populations is needed to obtain stronger conclusions.

References and/or Acknowledgements

  1. Patriarca F, Sperotto A, Damiani D, et al. Infliximab treatment for steroid-refractory acute graft-versus-host disease. Haematologica 2004;89:1352–9

References and/or AcknowledgementsNo conflict of interest.

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