Scientific Publications Database

Article Title: Phase II trial of natalizumab with corticosteroids as initial treatment of gastrointestinal acute graft-versus-host disease
Authors: Kekre, Natasha; Kim, Haesook T.; Hofer, Julia; Ho, Vincent T.; Koreth, John; Armand, Philippe; Nikiforow, Sarah; Gooptu, Mahasweta; Romee, Rizwan; Alyea, Edwin P.; Nageshwar, Prashant; Glotzbecker, Brett; El-Jawahri, Areej; DeFilipp, Zachariah; Soiffer, Robert J.; Antin, Joseph H.; Chen, Yi-Bin; Cutler, Corey
Journal: BONE MARROW TRANSPLANTATION Volume 56 Issue 5
Date of Publication:2021
Abstract:
The alpha 4ss7 integrin is upregulated on naive and memory T cell subsets in patients who subsequently develop gastrointestinal (GI) acute GVHD. Natalizumab (Tysabri(R), Biogen Inc.) acts against the alpha 4 subunit that mediates homing of lymphocytes to the GI tract. We initiated a phase II study of natalizumab with corticosteroids for initial treatment of acute GI GVHD. In total, 300 mg IV of natalizumab was given, with steroids initiated up to 3 days prior. Twenty-one subjects were treated, median age was 63 years (range 38-74), and 15 (71%) were male. Eighteen (86%) underwent RIC, 15 (71%) received MUD, and all received PBSCs. Overall GVHD at enrollment was grade II in 4 and grade III in 17. The primary endpoint, day 56 GVHD-free survival rate, was attained in 33.3%. The overall response rate at day 28 and 56 was 57% and 52%, respectively. Six of eight CRs were durable for 1 year. Five experienced toxicity possibly related to natalizumab and ten had infections before day 100. 2-year OS was 43% (95% CI 22-62%) and 2-year NRM was 52% (95% CI 29-71%). Natalizumab with corticosteroids as initial treatment of acute GI GVHD is safe, effective, and durable.