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Recombinant human interleukin-1 receptor antagonist in the treatment of steroid-resistant graft-versus-host disease.
- Source :
-
Blood [Blood] 1994 Aug 15; Vol. 84 (4), pp. 1342-8. - Publication Year :
- 1994
-
Abstract
- Acute graft-versus-host disease (GVHD) that is resistant to therapy is a highly lethal complication of marrow transplantation. Inflammatory cytokines such as interleukin-1 (IL-1) may be critical mediators of this process. If so, specific inhibition of IL-1 activity with recombinant human IL-1 receptor antagonist (IL-1Ra), a naturally occurring competitive inhibitor of IL-1, may ameliorate acute GVHD. We performed an open-label, phase I/II trial to evaluate the safety and efficacy of IL-1Ra in 17 patients with steroid-resistant GVHD. The IL-1Ra was administered as a 24-hour continuous infusion over 7 days. The dose was escalated in cohorts of patients from 400 to 3,200 mg/d. Acute GVHD was evaluated in each affected organ and as an overall grade. Stage-specific improvement of acute GVHD occurred in the skin (8 of 14, 57%), gut (9 of 11, 82%), and liver (2 of 11, 18%). Overall, acute GVHD improved by at least one grade in 10 of 16 (63%) patients. Response to therapy was associated with a reduction of tumor necrosis factor-alpha (TNF-alpha) mRNA levels in blood mononuclear cells (P = .001). The only toxicity attributable to IL-1Ra was reversible transaminase elevation in two patients. Inhibition of IL-1 activity with IL-1Ra is safe and has demonstrable efficacy in acute GVHD that failed to respond to conventional treatment. These data provide further evidence that IL-1 is a mediator of GVHD.
- Subjects :
- Adult
Anemia, Aplastic therapy
Child, Preschool
Cytokines biosynthesis
Cytokines blood
Drug Resistance
Humans
Interleukin 1 Receptor Antagonist Protein
Leukemia therapy
Leukocytes, Mononuclear drug effects
Leukocytes, Mononuclear immunology
Leukocytes, Mononuclear metabolism
Middle Aged
Multiple Myeloma therapy
Myelodysplastic Syndromes therapy
RNA, Messenger biosynthesis
Receptors, Interleukin-1 metabolism
Recombinant Proteins therapeutic use
Treatment Outcome
Bone Marrow Transplantation immunology
Graft vs Host Disease drug therapy
Receptors, Interleukin-1 antagonists & inhibitors
Sialoglycoproteins therapeutic use
Steroids therapeutic use
Subjects
Details
- Language :
- English
- ISSN :
- 0006-4971
- Volume :
- 84
- Issue :
- 4
- Database :
- MEDLINE
- Journal :
- Blood
- Publication Type :
- Academic Journal
- Accession number :
- 8049450