Effect of up-front daclizumab when combined with steroids for the treatment of acute graft-versus-host disease

Results of a randomized trial

Stephanie J. Lee, David Zahrieh, Edward Agura, Margaret L. MacMillan, Richard T. Maziarz, Philip L. McCarthy, Vincent T. Ho, Corey Cutler, Edwin P. Alyea, Joseph H. Antin, Robert J. Soiffer

Research output: Contribution to journalArticle

150 Citations (Scopus)

Abstract

The standard initial therapy for acute graft-versus-host disease (GVHD) is corticosteroids. Daclizumab is a humanized monoclonal antibody against the interleukin 2 (IL-2) receptor expressed on activated T lymphocytes. Because of daclizumab's favorable toxicity profile and response rate in steroid-resistant GVHD, a multicenter, double-blinded, randomized study of corticosteroids with or without daclizumab for initial treatment of acute GVHD was conducted. A total of 102 evaluable subjects of the targeted 166 were enrolled at 5 participating sites. Methylprednisolone at a dose of 2 mg/kg or daily equivalent was given in conjunction with daclizumab 1 mg/kg or placebo on study days 1, 4, 8, and weekly as long as clinically indicated. The groups were balanced for clinical characteristics. GVHD response rates by study day 42 were similar (53% vs 51%; P = .85). The study was halted after a planned interim analysis showed a significantly worse 100-day survival in the group receiving corticosteroids plus daclizumab (77% vs 94%; P = .02). Overall survival at 1 year was also inferior in the combination arm (29% vs 60%; P= .002). Both relapse- and GVHD-related mortality contributed to the increased mortality in the combination group. The combination of corticosteroids and daclizumab should not be used as initial therapy of acute GVHD.

Original languageEnglish (US)
Pages (from-to)1559-1564
Number of pages6
JournalBlood
Volume104
Issue number5
DOIs
StatePublished - Sep 1 2004

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Graft vs Host Disease
Grafts
Steroids
Adrenal Cortex Hormones
Therapeutics
Antibodies, Monoclonal, Humanized
T-cells
Mortality
Interleukin-2 Receptors
Methylprednisolone
Toxicity
daclizumab
Placebos
T-Lymphocytes
Recurrence

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Effect of up-front daclizumab when combined with steroids for the treatment of acute graft-versus-host disease : Results of a randomized trial. / Lee, Stephanie J.; Zahrieh, David; Agura, Edward; MacMillan, Margaret L.; Maziarz, Richard T.; McCarthy, Philip L.; Ho, Vincent T.; Cutler, Corey; Alyea, Edwin P.; Antin, Joseph H.; Soiffer, Robert J.

In: Blood, Vol. 104, No. 5, 01.09.2004, p. 1559-1564.

Research output: Contribution to journalArticle

Lee, SJ, Zahrieh, D, Agura, E, MacMillan, ML, Maziarz, RT, McCarthy, PL, Ho, VT, Cutler, C, Alyea, EP, Antin, JH & Soiffer, RJ 2004, 'Effect of up-front daclizumab when combined with steroids for the treatment of acute graft-versus-host disease: Results of a randomized trial', Blood, vol. 104, no. 5, pp. 1559-1564. https://doi.org/10.1182/blood-2004-03-0854
Lee, Stephanie J. ; Zahrieh, David ; Agura, Edward ; MacMillan, Margaret L. ; Maziarz, Richard T. ; McCarthy, Philip L. ; Ho, Vincent T. ; Cutler, Corey ; Alyea, Edwin P. ; Antin, Joseph H. ; Soiffer, Robert J. / Effect of up-front daclizumab when combined with steroids for the treatment of acute graft-versus-host disease : Results of a randomized trial. In: Blood. 2004 ; Vol. 104, No. 5. pp. 1559-1564.
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