Recombinant human tumor necrosis factor receptor fusion protein as complementary treatment for chronic graft-versus-host disease

Background. Chronic graft-versus-host disease (cGVHD) remains one of the major late complications in allogeneic bone marrow transplantation (BMT).Prolonged immunosuppression often results in significant morbidity and mortality. Cytokine dysregulation is implicated in the pathophysiology of cGVHD, and tumor necrosis factor-alpha (TNF-alpha) plays a central role. Methods. Recombinant soluble TNF receptor (Enbrel) was explored for the use of steroid-dependent cGVHD in 10 patients. Enbrel was given as a subcutaneous injection twice weekly for 4 weeks followed by once weekly for 4 more weeks. Progression or regression of cGVHD was monitored closely by regular clinical follow-up. Results. Eight patients finished the 8-week treatment course without adverse side effect. Seven of them showed improvement (subjectively and/or objectively) in cGVHD. Steroid taper was initiated as early as 1 month. Conclusions. This preliminary encouraging result merits additional studies to optimize Enbrel as a potential complementary therapy for resolution of steroid-dependent cGVHD.