Abstract
Daclizumab, a humanized IL-2 receptor antagonist, has been found to be safe and effective in adults with refractory graft-versus-host disease (GVHD); however, data describing its efficacy for refractory GVHD in children are limited. We report a series of 14 children who were treated with daclizumab for severe acute and/or chronic corticosteroid refractory GVHD. Patients were treated with 2 mg/kg weekly for 8 weeks followed by 1 mg/kg weekly for 4 weeks. Nine of 14 patients responded to daclizumab as measured by improvement of GVHD symptoms, and the ability to substantially wean corticosteroid dose. Five of 11 patients with acute GVHD had complete symptom resolution, and 2/11 had a partial response. Two of four patients with chronic GVHD had complete symptom resolution. In these patients, daclizumab was only effective in treating skin GVHD. Seven of the nine patients who had a complete or partial response eventually had recurrence of GVHD; however, the GVHD was less severe and no longer corticosteroid refractory. There was no infusional toxicity, and no infections that could be attributable to the drug. Daclizumab is a relatively safe and effective medication for corticosteroid refractory GVHD in children and larger studies are needed to evaluate its role in treatment.
This is a preview of subscription content, access via your institution
Access options
Subscribe to this journal
Receive 12 print issues and online access
$259.00 per year
only $21.58 per issue
Buy this article
- Purchase on Springer Link
- Instant access to full article PDF
Prices may be subject to local taxes which are calculated during checkout
Similar content being viewed by others
References
Ferrara JL, Cooke KR, Teshima T . The pathophysiology of acute graft-versus-host disease. Int J Hematol 2003; 78: 181–187.
Przepiorka D, Kernan NA, Ippoliti C, Papadopoulos EB, Giralt S, Khouri I et al. Daclizumab, a humanized anti-interleukin-2 receptor alpha chain antibody, for treatment of acute graft-versus-host disease. Blood 2000; 95: 83–89.
Swiatecka-Urban A . Anti-interleukin-2 receptor antibodies for the prevention of rejection in pediatric renal transplant patients: current status. Paediatr Drugs 2003; 5: 699–716.
van Mourik ID, Kelly DA . Immunosuppressive drugs in paediatric liver transplantation. Paediatr Drugs 2001; 3: 43–60.
Willenbacher W, Basara N, Blau IW, Fauser AA, Kiehl MG . Treatment of steroid refractory acute and chronic graft-versus-host disease with daclizumab. Br J Haematol 2001; 112: 820–823.
Srinivasan R, Chakrabarti S, Walsh T, Igarashi T, Takahashi Y, Kleiner D et al. Improved survival in steroid-refractory acute graft-versus-host disease after non-myeloablative allogeneic transplantation using a daclizumab-based strategy with comprehensive infection prophylaxis. Br J Haematol 2004; 124: 777–786.
Wolff D, Roessler V, Steiner B, Wilhelm S, Weirich V, Brenmoehl J et al. Treatment of steroid-resistant acute graft-versus-host disease with daclizumab and etanercept. Bone Marrow Transplant 2005; 35: 1003–1010.
Pietra BA, Boucek MM . Immunosuppression for pediatric cardiac transplantation in the modern era. Prog Pediatr Cardiol 2000; 11: 115–129.
Abu-Elmagd K, Fung J, McGhee W, Martin D, Mazariegos G, Schaefer N et al. The efficacy of daclizumab for intestinal transplantation: preliminary report. Transplant Proc 2000; 32: 1195–1196.
Anasetti C, Hansen JA, Waldmann TA, Appelbaum FR, Davis J, Deeg HJ et al. Treatment of acute graft-versus-host disease with humanized anti-Tac: an antibody that binds to the interleukin-2 receptor. Blood 1994; 84: 1320–1327.
website F . www.fda.gov/medwatch/SAFETY/2003/zenapax.htm.
Church AC . Clinical advances in therapies targeting the interleukin-2 receptor. Qjm 2003; 96: 91–102.
Lee SJ, Zahrieh D, Agura E, MacMillan ML, Maziarz RT, McCarthy Jr PL . et al. Effect of up-front daclizumab when combined with steroids for the treatment of acute graft-versus-host disease: results of a randomized trial. Blood 2004; 104: 1559–1564.
Pescovitz MD, Bumgardner G, Gaston RS, Kirkman RL, Light S, Patel IH et al. Pharmacokinetics of daclizumab and mycophenolate mofetil with cyclosporine and steroids in renal transplantation. Clin Transplant 2003; 17: 511–517.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Teachey, D., Bickert, B. & Bunin, N. Daclizumab for children with corticosteroid refractory graft-versus-host disease. Bone Marrow Transplant 37, 95–99 (2006). https://doi.org/10.1038/sj.bmt.1705199
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1038/sj.bmt.1705199
Keywords
This article is cited by
-
Current and Emerging Targeted Therapies for Acute Graft-Versus-Host Disease
BioDrugs (2021)
-
More than skin deep? Emerging therapies for chronic cutaneous GVHD
Bone Marrow Transplantation (2013)
-
Daclizumab as useful treatment in refractory acute GVHD: a paediatric experience
Bone Marrow Transplantation (2009)
-
Acute graft-versus-host disease in children
Bone Marrow Transplantation (2008)