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Yanik GA, Grupp SA, Pulsipher MA, Levine JE, Schultz KR, Wall DA, Langholz B, Dvorak CC, Alangaden K, Goyal RK, White ES, Collura JM, Skeens MA, Eid S, Pierce EM, Cooke KR. TNF-receptor inhibitor therapy for the treatment of children with idiopathic pneumonia syndrome. A joint Pediatric Blood and Marrow Transplant Consortium and Children's Oncology Group Study (ASCT0521). Biol Blood Marrow Transplant 2014; 21:67-73. [PMID: 25270958 DOI: 10.1016/j.bbmt.2014.09.019] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Accepted: 09/24/2014] [Indexed: 10/24/2022]
Abstract
Idiopathic pneumonia syndrome (IPS) is an acute, noninfectious lung disorder associated with high morbidity and mortality after hematopoietic cell transplantation. Previous studies have suggested a role for TNFα in the pathogenesis of IPS. We report a multicenter phase II trial investigating a soluble TNF-binding protein, etanercept (Enbrel, Amgen, Thousand Oaks, CA), for the treatment of pediatric patients with IPS. Eligible patients were < 18 years old, within 120 days after transplantation, and with radiographic evidence of a diffuse pneumonitis. All patients underwent a pretherapy broncho-alveolor lavage (BAL) to establish the diagnosis of IPS. Systemic corticosteroids (2.0 mg/kg/day) plus etanercept (.4 mg/kg twice weekly × 8 doses) were administered. Response was defined as survival and discontinuation of supplemental oxygen support by day 28 of study. Thirty-nine patients (median age, 11 years; range, 1 to 17) were enrolled, with 11 of 39 patients nonevaluable because of identification of pathogens from their pretherapy BAL. In the remaining 28 patients, the median fraction of inspired oxygen at study entry was 45%, with 17 of 28 requiring mechanical ventilation. Complete responses were seen in 20 (71%) patients, with a median time to response of 10 days (range, 1 to 24). Response rates were higher for patients not requiring mechanical ventilation at study entry (100% versus 53%, P = .01). Overall survival at 28 days and 1 year after therapy were 89% (95% confidence interval [CI], 70% to 96%) and 63% (95% CI, 42% to 79%), respectively. Plasma levels of proinflammatory cytokines were significantly increased at onset of therapy, subsequently decreasing in responding patients. The addition of etanercept to high-dose corticosteroids was associated with high response rates and survival in children with IPS.
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Affiliation(s)
- Gregory A Yanik
- Department of Pediatrics, Blood and Marrow Transplant Program, University of Michigan, Ann Arbor, Michigan.
| | - Stephan A Grupp
- Division of Oncology, Children's Hospital of Philadelphia and Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Michael A Pulsipher
- Division of Hematology and Hematological Malignancies, Primary Children's Hospital, Salt Lake City, Utah
| | - John E Levine
- Department of Pediatrics, Blood and Marrow Transplant Program, University of Michigan, Ann Arbor, Michigan
| | - Kirk R Schultz
- Department of Pediatrics, Pediatric Hematology/Oncology/BMT, British Columbia Children's Hospital and University of British Columbia, Vancouver, British Columbia, Canada
| | - Donna A Wall
- Department of Pediatrics, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Bryan Langholz
- Children's Oncology Group Statistics and Data Center, University of Southern California, Arcadia, California
| | - Christopher C Dvorak
- Department of Pediatrics, UCSF Benioff Children's Hospital, University of California San Francisco, San Francisco, California
| | - Keith Alangaden
- Department of Pediatrics, Blood and Marrow Transplant Program, University of Michigan, Ann Arbor, Michigan
| | - Rakesh K Goyal
- Division of Pediatric Hematology-Oncology, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Eric S White
- Division of Critical Care and Pulmonary Medicine, University of Michigan, Ann Arbor, Michigan
| | - Jennifer M Collura
- School of Pharmacy, Indiana University-Riley Children's Hospital, Indianapolis, Indiana
| | - Micah A Skeens
- Department of Nursing, Nationwide Children's Hospital, Columbus, Ohio
| | - Saada Eid
- Division of Hematology and Oncology, Department of Pediatrics, Case Western Reserve University, School of Medicine, Cleveland, Ohio
| | - Elizabeth M Pierce
- Division of Hematology and Oncology, Department of Pediatrics, Case Western Reserve University, School of Medicine, Cleveland, Ohio
| | - Kenneth R Cooke
- Department of Oncology, Sidney Kimmel Cancer Center, Johns Hopkins University, School of Medicine, Baltimore, Maryland
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