Çoklu İlaca Dirençli Akut Graft Versus Host Hastalığında Ruksolitinib

Abstract

Objective: Graft versus host disease (GvHD) is the most important cause of morbidity and mortality in allogeneic stem cell transplantation (Allo-SCT). Ruxolitinib is an oral Janus Kinase (JAK) 1/2 inhibitor and is effective in treatment resistant GvHD. Patients and Methods: Eighteen patients with GVHD on ruxolitinib treatment during 2018- 2020 in Karadeniz Technical University Hematology department were evaluated retrospectively. Results: Median time to first response of ruxolitinib was 0.5 months (0.5-0.7) and overall response time was 2.3 months (0.8-7.8) (IQR). The response rate on 28th day was 61.1%. Overall survival was 2.5 months (1.2-10.1) in which 3.4 months (2-16.5) in the group of ruxolitinib responders and 1.1 months (0.8-2.5) (IQR) in the group of ruxolitinib non responsers. In ruxolitinib responders, 8 patients (66.7%) were alive and, 4 patients (33.3%) were dead while in nonresponders 6 patients (100%) were dead (p= 0.013). The overall survival was significantly higher in those with VGPR compared with those who did not (p= 0.001). Bacteremia developed in 7 patients (%38.9), and 6 o these were unresponsive to ruxolitinib treatment. Conclusion: Ruxolitinib is safe and effective in multidrug resistant aGvHH. Deaths due to bacteremia and sepsis occur less frequently in patients who respond to treatment, thus prolonging survival. The depth of tretment response in GvHH is a very important determination of long term survival.