The impact of soluble tumor necrosis factor receptor etanercept on the treatment of idiopathic pneumonia syndrome after allogeneic hematopoietic stem cell transplantation

Gregory A. Yanik, Vincent T. Ho, John E. Levine, Eric S. White, Thomas Braun, Joseph H. Antin, Joel Whitfield, Joseph Custer, Dawn Jones, James L M Ferrara, Kenneth R Cooke

Research output: Contribution to journalArticle

Abstract

Idiopathic pneumonia syndrome (IPS) refers to a diffuse, noninfectious, acute lung injury after hematopoietic stem cell transplantation. Historically, IPS is associated with respiratory failure and mortality rates exceeding 50%. Preclinical studies have implicated tumor necrosis factor-α as an important effector molecule in the development of disease. We studied the tumor necrosis factor-α inhibitor, etanercept, combined with corticosteroids in treating 15 patients (median age, 18 years; range, 1-60 years) with IPS. Eight of 15 patients required mechanical ventilation at therapy onset. Etanercept was administered subcutaneously at a dose of 0.4 mg/kg (maximum 25 mg) twice weekly, for a maximum of 8 doses. Therapy was well tolerated with no infectious pulmonary complications noted. Ten of 15 patients had a complete response, defined as the ability to discontinue supplemental oxygen support during study therapy. The median time to complete response was 7 days (range, 3-18 days), with a day 28 survival of 73%. IPS onset was associated with elevations of several inflammatory proteins in the bronchoalveolar lavage fluid and plasma, and response to therapy correlated with reductions in pulmonary and systemic inflammation. The combination of etanercept and corticosteroids is safe and is associated with high response rates and improved survival in patients with IPS.

Original languageEnglish (US)
Pages (from-to)3073-3081
Number of pages9
JournalBlood
Volume112
Issue number8
DOIs
StatePublished - Oct 15 2008
Externally publishedYes

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Tumor Necrosis Factor Receptors
Hematopoietic Stem Cell Transplantation
Stem cells
Pneumonia
Adrenal Cortex Hormones
Tumor Necrosis Factor-alpha
Therapeutics
Oxygen
Plasmas
Molecules
Fluids
Acute Lung Injury
Bronchoalveolar Lavage Fluid
Respiratory Rate
Artificial Respiration
Respiratory Insufficiency
Etanercept
Proteins
Survival Rate
Lung

ASJC Scopus subject areas

  • Hematology
  • Biochemistry
  • Cell Biology
  • Immunology

Cite this

The impact of soluble tumor necrosis factor receptor etanercept on the treatment of idiopathic pneumonia syndrome after allogeneic hematopoietic stem cell transplantation. / Yanik, Gregory A.; Ho, Vincent T.; Levine, John E.; White, Eric S.; Braun, Thomas; Antin, Joseph H.; Whitfield, Joel; Custer, Joseph; Jones, Dawn; Ferrara, James L M; Cooke, Kenneth R.

In: Blood, Vol. 112, No. 8, 15.10.2008, p. 3073-3081.

Research output: Contribution to journalArticle

Yanik, GA, Ho, VT, Levine, JE, White, ES, Braun, T, Antin, JH, Whitfield, J, Custer, J, Jones, D, Ferrara, JLM & Cooke, KR 2008, 'The impact of soluble tumor necrosis factor receptor etanercept on the treatment of idiopathic pneumonia syndrome after allogeneic hematopoietic stem cell transplantation', Blood, vol. 112, no. 8, pp. 3073-3081. https://doi.org/10.1182/blood-2008-03-143412
Yanik, Gregory A. ; Ho, Vincent T. ; Levine, John E. ; White, Eric S. ; Braun, Thomas ; Antin, Joseph H. ; Whitfield, Joel ; Custer, Joseph ; Jones, Dawn ; Ferrara, James L M ; Cooke, Kenneth R. / The impact of soluble tumor necrosis factor receptor etanercept on the treatment of idiopathic pneumonia syndrome after allogeneic hematopoietic stem cell transplantation. In: Blood. 2008 ; Vol. 112, No. 8. pp. 3073-3081.
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