Infliximab for Managing Steroid-Refractory Acute Graft-versus-Host Disease

Received 25 March 2009; accepted 15 May 2009.

Infliximab has demonstrated activity in the treatment of steroid-refractory acute graft-versus-host disease (aGVHD). We aimed to confirm the effectiveness of infliximab as a salvage therapy for steroid-refractory aGVHD. In a series of 52 patients, 71% of whom had grade III-IV aGVHD, only 15% achieved complete remission (CR) with the use of infliximab alone as salvage therapy. CR of aGVHD differed according to overall aGVHD grade at salvage (grade II, 5/15; grade III, 2/17; grade IV, 1/20; P=.03). Median overall survival (OS) was only 1.7 months (95% confidence interval [CI]=0.99 to 2.3 months). CR of aGVHD was significantly associated with OS, with a hazard ratio of 8.4 for death in those without CR (95% CI=3.6 to 19.6; P < .0001). This series demonstrates the limited activity of infliximab in patients with high-grade aGVHD. Further work is needed to identify effective therapy for aGVHD.

Key Words: Infliximab, Steroid-refractory, Acute graft-versus-host disease

1 Department of Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida

2 Department of Biostatistics, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida

3 Department of Oncological Sciences, University of South Florida, Tampa, Florida

Correspondence and reprint requests: Joseph Pidala, MD, Moffitt Cancer Center, 12902 Magnolia Drive, MCC-GME, Tampa, FL 33612-9416.

Financial disclosure: See Acknowledgments on page 1120.

PII: S1083-8791(09)00253-5

doi:10.1016/j.bbmt.2009.05.019

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