OKT3 muromonab as second-line and subsequent treatment in recipients of stem cell allografts with steroid-resistant acute graft-versus-host disease

S. Knop, H. Hebart, H. Gscheidle, E. Holler, H. J. Kolb, D. Niederwieser, H. Einsele

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22 Scopus citations

Abstract

We retrospectively evaluated response to monoclonal antibody directed against CD3 (OKT3) treatment in 43 patients with steroid-resistant acute graft-versus-host disease (aGvHD) following allogeneic hematopoietic cell transplantation. Median duration of OKT3 therapy was 9 (range, 1 -20) days. In all, 20 cycles were administered as second-line and 28 as third-plus line treatment. Side effects were mild to moderate. Overall response rate was 69 with 12% complete remissions and best response in skin involvement. Proportional reduction of concomitant steroids was higher in responding patients. Five patients (12%) achieved durable responses. Pharmacokinetic studies of OKT3 showed adequate plasma levels (≥1000 ng/ml) in 13 of 17 evaluable patients after a median of 6 (1-11) days on treatment. OKT3 became undetectable shortly after discontinuation of therapy. Median survival for all patients was 80 (2 to 2474+) days. There was a trend for better survival for patients on second-line vs third-plus line treatment (146 vs 46 days; P=0.07) and significant longer survival for patients with grade II when compared to those with grade III/IV aGvHD (206 vs 47 days; P=0.039). We conclude that salvage treatment with OKT3 shows considerable efficiency, however, sometimes of transient nature, and is well tolerated in patients with corticosteroid-resistant aGvHD.

Original languageEnglish
Pages (from-to)831-837
Number of pages7
JournalBone Marrow Transplantation
Volume36
Issue number9
DOIs
StatePublished - Nov 2005
Externally publishedYes

Keywords

  • Graft-versus-host disease
  • Monoclonal antibody
  • OKT3
  • Stem cell transplantation

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