Alemtuzumab in the treatment of steroid refractory acute graft-versus-host disease
Transplant patients take immunosuppressive medications for several years after undergoing transplantation. Graft Versus Host Disease (GVHD) is a common complication after allogeneic transplant that can have negative effects on the skin, liver, and gastrointestinal tract. The most common treatment for both preventing and treating a GVHD flare is steroids, but long-term use of steroids has its own complications, and in some cases, the GVHD can stop responding to them. In this study, patients received steroids and methotrexate for GVHD prevention, while alemtuzumab was given to treat GVHD flare ups.
The study enrolled patients who experienced GVHD as follows: 8 patients classified as grade II; 5 patients with grade III, and 2 patients with grade IV. About half the patients developed the GVHD within the first 100 days after transplant. Patients were treated with alemtuzumab 10mg, given subcutaneously on days 1-5. This was in addition to the steroids and methotrexate they were taking for prophylaxis.
Complete resolution of GVHD was seen in 23% of patients, partial response was seen in 62%, and no response was seen in 15%. This study showed that alemtuzumab can be used safely and effectively for treatment of GVHD, while also opening the door for more research into incorporating the drug earlier in the course of GVHD.