Review Article

Novel Pharmacological Treatment Options of Steroid-Refractory Graft-versus-Host Disease

Table 1

Novel drugs in the treatment of SR-aGVHD.

AuthorStudy typeDrugMechanism of actionTreatment regimenORRCRSurvivalGrade 3-4 AEs

Jagasia et al.Prospective, multicenter, open-label, single-cohort, phase IIRuxolitinibJAK1 and JAK2 kinase inhibitor5 mg BID with an increase to 10 mg BID73.2%56.3%MS of 7.6 monthsThrombocytopenia (61%); anemia (45%); infections (40%); neutropenia (40%); hemorrhage (20%); fatigue (14%); elevated transaminases (14%); edema (13%); hypertension (13%); thrombosis (11%); dyspnea (7%); diarrhea (7%); headache (4%); and rash (3%)

Bordigoni et al.Prospective, single-center, open-label, multicohort, phase IIDaclizumabIL-2Rα antagonists1 mg/kg on days 1, 4, 8, 15, and 2290.1%68.8%4-year EFS 54.6%38.7% CMV reactivation

Groth et al.Prospective, single-arm, phase I/II for safety and efficacyCD3/CD7-ITAntibodies to CD3/CD7 antigensFour doses 4 mg/m260% on day 2850%6-months OS 60%Grade 3: thrombocytopenia (15%), neutropenia (5%), elevated bilirubin (10%), myopathy (5%), microangiopathy (5%), hypoalbuminemia (5%)
2-year OS 35%Grade 4: thrombocytopenia (25%)

Socié et al.Phase III, randomized, open-label, multicenterInolimomabMonoclonal antibody to CD25Days 1–8 = 0.3 mg/kg/d IV for induction phase and 0.2 mg/kg/d IV for maintenanceNRNR1-year OS 28.5%At least one grade 3, 4, or 5 = 100% in treatment group; 98% in control group
If CR on day 9, maintenance injection on days 9–28

Mehta et al.Prospective studyVedolizumabMonoclonal antibody which inhibits interaction between a4b7 on T-cells with MAdCAM-1 on endotheliumIV infusion at a dose of 300 mg at 0, 2, and 6 weeks, and then every 8 weeks depending on the response25%20%35% at 6 monthsInfections, liver enzymes elevation

Bacigalupo et al.Analysis of 2 prospective studiesBegelomabMonoclonal antibody to CD26From 2 to 4.5 mg/m2/day75% and 61%11% and 12%50% and 30% at 1 yearGroup I: bronchopneumonia (25%), dyspnea (16.6%)
Group II: bacterial sepsis, convulsions, acute respiratory failure, multiorgan failure, E. coli infection with renal failure (0.06%, 1 patient)

Bolaños-Meade et al.Single-center, phase I dose-escalation studyPentostatinNucleoside inhibitor1 to 4 mg/m2/d for 3 days76%63%MS 85 daysThrombocytopenia 4%, late infections 9%

Benito et al.Pilot trial for toxicity and efficacySirolimusmTOR inhibitor19% of patients 15 mg/m2 oral loading dose day 1 + 5 mg/m2/d for 13 days57%24%400-day OS 28%Myelosuppression 9%, seizures 9%
33% given 5 mg/m2/day for 14 days without loading dose
48% received 4 mg/m2/day for 14 days without loading dose

Carpenter et al.Multicenter, single-arm, phase IIVisilizumabMonoclonal antibody to CD25 and CD3First dose 3 mg/m2; second dose if recurrence in 2–6 weeks32%14%180-day OS 32%Infusion reaction (4.5%)
310-day OS 20.5%
MS 539 days

Ho et al.Single-center, multi-cohort, prospective, phase IDenileukin diftitoxCytotoxicity against IL-2 receptors23% of patients 9 μg/kg on days 1 and 1571%50%6.3–26.4 months OS 33%Hepatic transaminitis (4%); infusion reaction (6%); acute renal failure (4%); cardiac tamponade (4%); pulmonary embolism (4%); sepsis (11%)
60% of patients 9 μg/kg IV on days 1, 3, 5, 15, 17, and 19 (maximum tolerated dose)MS 7.2 months
17% of patients given 9 μg/kg IV days 1–5 and 15–19

Schroeder et al.Open-label, parallel-cohort, multicenter, phase IItacitinibJAK1-inhibitor200 mg once daily + corticosteroids or 300 mg once daily + corticosteroids75% in 200 mg group37.5% in 200 mg group6-month OS 58.6%200 mg group vs. 300 mg group: diarrhea (28.6% vs. 13.3%), edema (0% vs. 1%); abdominal pain (14.3% vs. 6.7%), hypokalemia (28.6% vs. 20.0%), hyperglycemia (21.4% vs. 26.7%), fatigue (28.6% vs. 0%), decreased appetite (14.3% vs. 6.7%), tachycardia (14.3% vs. 0%), hypoalbuminemia (21.4% vs. 6.7%), hypophosphatemia (21.4% vs. 13.3%), nausea (0% vs. 6.7%), and vomiting (0% vs. 6.7%)
66.7% in 300 mg22.2% in 300 mg12-month OS 48.3%

Marcondes et al.Phase I/II open-label single-center study,Alpha-1 antitripsinSerine protease inhibitor with anti-inflammatory propertiesCohort 1: 90 mg/kg on day 1; 30 mg/kg/day on days 3, 5, 7, 9, 11, 13, and 15. Cohort 2: 90 mg/kg on day 1; 60 mg/kg/day66.6%33.3%50% at >104 to >820 daysNone

ORR = overall response rate; CR = complete response; AEs = adverse events; BID = twice daily; MS = median survival; OS = overall survival; EFS = event-free survival; NR = not reported; CG = control group; IL-2Rα = IL-2 receptor α.