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Quartal 1999 Stem Cell
Transplantation: Treatment With a Monoclonal Antibody
Against Interleukin 2 Receptor in Severe GvHD Graft versus host disease (GvHD) is still one of the major contributors to mortality and morbidity post stem cell transplantation (SCT) especially in the setting of matched unrelated donor (MUD) or HLA mismatched SCT. This is illustrated for example by the fact that 35% of patients after MUD BMT for chronic myeloid leukemia (CML) in a recently published cohort developed II°-IV° acute GvHD while only 10% of these patients relapsed of which half could be salvaged by additional treatments. While steroid dose escalation is the cornerstone of treatment strategies for severe acute GvHD patients prognosis becomes worse if GvHD does not respond to dosages in the range of 2 mg/kg Methylprednisolon. Anonther option is to antagonize the action of inflammatory cytokines by monoclonal antibodies to stop the detrimental immunological cascade reaction of GvHD. One key cytokine in the evolution of GvHD is interleukin 2 (IL-2). Therefore, treatment with a monoclonal antibody against interleukin 2 receptor might be beneficial in severe GvHD. We herein report our first data on a recombinant human interleukin 2 receptor antagonist (rhIL-2ra) in severe chronic and acute GvHD refractory to high dose methylprednisolone with or without mycophenolate mofetil. Eight of nine patients respond to rhIL-2ra within 21 days after treatment initiation, whereas one patient died due to severe refractory GvHD of the gut. In addition to other investigators we are able to demonstrate a clear benefit of rhIL-2ra in chronic GvHD. In conclusion rhIL-2ra might be a very powerful tool in the treatment of steroid refractory acute and chronic GvHD. Key words: Graft-versus-host disease (GvHD), interleukin 2 (IL-2), interleukin 2 receptor antagonist, cytokines, treatment PD Dr. M. G. Kiehl © 1999 Pabst Science Publishers |
