Basiliximab for the Treatment of Steroid-Refractory Acute Graft-Versus-Host Disease After Unmanipulated HLA-Mismatched/Haploidentical Hematopoietic Stem Cell Transplantation

• Published in: Transplantation proceedings Vol. 43; no. 5; pp. 1928 - 1933
• Main Authors: Wang, J.Z, Liu, K.Y, Xu, L.P, Liu, D.H, Han, W, Chen, H, Chen, Y.H, Zhang, X.H, Zhao, T, Wang, Y, Huang, X.J
• Format: Journal Article
• Language: English
• Published: Amsterdam Elsevier Inc 01-06-2011; Elsevier
• Subjects: Acute Disease; Adolescent; Adult; Antibodies, Monoclonal - therapeutic use; Biological and medical sciences; Child; Female; Fundamental and applied biological sciences. Psychology; Fundamental immunology; Graft vs Host Disease - diagnosis; Graft vs Host Disease - drug therapy; Haplotypes; Hematopoietic Stem Cell Transplantation - adverse effects; Histocompatibility Testing; Humans; Immunosuppressive Agents - therapeutic use; Infection - complications; Male; Medical sciences; Middle Aged; Recombinant Fusion Proteins - therapeutic use; Retrospective Studies; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Tissue, organ and graft immunology; Young Adult; Incompatibility; Steroid; Immunopathology; Corticosteroid; Graft versus host disease; HLA-System; Treatment resistance; Haploidentical graft; Acute; Stem cell; Major histocompatibility system; Hematopoietic cell; Homograft; Transplantation; Monoclonal antibody; Immunomodulator; Medicine; Refractory; Treatment; Surgery; Basiliximab; Immunotherapy; Immunosuppressive agent; Hematopoietic stem cell transplantation
• ISSN: 0041-1345; 1873-2623
• DOI: 10.1016/j.transproceed.2011.03.044

Abstract Background Anti-CD25 monoclonal antibodies (Mabs) have been evaluated for the treatment of steroid-refractory acute graft-versus-host disease (GVHD) in patients undergoing hematopoietic stem cell transplantation (HSCT) mainly with matched donors for years, but there is little attention concerning patients with unmanipulated human leukocyte antigen (HLA)-mismatched/haploidentical transplantations. We investigated the efficacy and safety of the chimeric Mab, basiliximab, to treat steroid-refractory acute GVHD after unmanipulated mismatched/haploidentical HSCT. Methods Fifty-three patients who developed steroid-refractory acute GVHD between July 2005 and July 2009 were treated at our institute with basiliximab. No prisoners were used in this study. Results Forty-six among 53 patients responded, including 37 complete remissions at a median response of 6 days from Mab initiation. There were 29 episodes of viral reactivations, 25 bacterial infections, and 11 probable fungal infections. Thirty-four out of 49 patients who could be evaluated developed chronic GVHD. Twenty-eight of 53 subjects (52.8%) were alive at a median follow-up of 16 months (range, 2–57) posttransplantation. The Kaplan–Meier probability of a 3-year event-free survival was 47.7%. The causes of death were infection alone ( n = 15), progressive GVHD with infection ( n = 3), relapse ( n = 3), and other etiologies ( n = 4). Conclusion These data suggested that basiliximab was effective to treat steroid-refractory acute GVHD after unmanipulated HLA-mismatched/haploidentical stem cell transplantation.