Tocilizumab Plus Standard of Care May Reduce Risk of Graft-Versus-Host-Disease After Stem-Cell Transplantation
the Cancer Therapy Advisor take:
According to a new study published in the journal The Lancet Oncology, researchers have found that the addition of tocilizumab to standard graft-versus-host disease (GVHD) prophylaxis following allogenic stem-cell transplantation may be effective to protect against acute GVHD.
Interleukin 6 is the key unregulated cytokine released after allogenic stem-cell transplantation, so the researchers sought to investigate whether tocilizumab, a humanized anti-interleukin 6 receptor monoclonal antibody, could inhibit interleukin 6, thereby preventing GVHD.
For the phase 1/2 study, researchers enrolled 48 patients aged 18 to 65 years who underwent T-replete HLA-matched allogenic stem-cell transplantation with either total body irradiation-based myeloblative or reduced-intensity conditioning from unrelated or sibling stem-cell donors.
Patients received cyclosporine and methotrexate, the standard GVHD prophylaxis, plus tocilizumab 8mg/kg (maximum dose 800mg) intravenously over 60 minutes the day before allogenic stem-cell transplantation. At day 100, 12% (95% CI: 5-24) of patients experienced grade 2-4 acute GVHD and 4% (95% CI: 1-13) experienced grade 3-4 acute GVHD.
Of the 48 patients, 10% developed grade 2-4 acute GVHD involving the skin and 8% developed acute GVHD involving the gastrointestinal tract. The researchers suggest a randomized, controlled study be conducted to assess the addition of tocilizumab to cyclosporine and methotrexate to reduce the risk for developing GVHD.
Addition of tocilizumab to standard GVHD prophylaxis following stem-cell transplantation may be effective.
Interleukin 6 is the main detectable and dysregulated cytokine secreted after allogeneic SCT and its inhibition is a potential new and simple strategy to protect from acute GVHD despite robust immune reconstitution; a randomised, controlled trial assessing tocilizumab in addition to standard GVHD prophylaxis in these patients is warranted.
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