Department of Pharmacy, The James Cancer Hospital, The Ohio State University Comprehensive Cancer Center , Columbus , Ohio , 43210 , USA.
Department of Pharmacy, Roswell Park Comprehensive Cancer Center , Buffalo , New York , USA.
Leuk Lymphoma. 2019 Sep;60(9):2223-2229. doi: 10.1080/10428194.2019.1573996. Epub 2019 Feb 15.
Acute graft-versus-host-disease (aGVHD) is a complication after allogeneic stem cell transplant. After the failure of treatment with high dose corticosteroids, steroid-refractory aGVHD (SR aGVHD) is associated with high rates of mortality. Tocilizumab has evidence of activity in SR aGVHD. For patients ineligible for trials, the OSU James Comprehensive Cancer Center has been utilizing tocilizumab as first-line therapy for SR aGVHD. We retrospectively report on 15 patients who received tocilizumab. aGVHD grading and responses were based on consensus criteria. Median age at transplant was 49 years. Median time to tocilizumab administration was 9 days (range, 3-16). Six patients had complete responses (40%) with a resolution of aGVHD. From the last contact, median overall survival for responders was not yet reached vs. 31 days for non-responders ( = .0002). Patients with skin and/or GI aGVHD demonstrated the greatest benefit. Patients with liver aGVHD did not respond. Future studies are needed to evaluate tocilizumab prior to steroid failure.
急性移植物抗宿主病（aGVHD）是异基因干细胞移植后的一种并发症。在高剂量皮质类固醇治疗失败后，类固醇难治性 aGVHD（SR aGVHD）与高死亡率相关。托珠单抗在 SR aGVHD 中具有活性证据。对于不符合试验条件的患者，俄亥俄州立大学詹姆斯癌症综合中心一直将托珠单抗作为 SR aGVHD 的一线治疗药物。我们回顾性报告了 15 名接受托珠单抗治疗的患者。aGVHD 分级和反应基于共识标准。移植时的中位年龄为 49 岁。托珠单抗给药的中位时间为 9 天（范围，3-16）。6 名患者（40%）完全缓解，aGVHD 得到解决。从最后一次随访来看，应答者的中位总生存期尚未达到，而非应答者为 31 天（=0.0002）。皮肤和/或胃肠道 aGVHD 的患者获益最大。肝 aGVHD 的患者没有反应。需要进一步的研究来评估在皮质类固醇失败之前使用托珠单抗。
