The use of ruxolitinib for acute graft-versus-host disease developing after solid organ transplantation

Abstract

Development of graft‐versus‐host disease (GvHD) is a rare complication after transfusions or solid organ transplantation. Patients typically present with a skin rash, diarrhea, liver failure, and bone marrow aplasia. A diagnosis of transfusion/transplantation associated‐GvHD is made based on the clinical and histologic evidence, yet it is often delayed due to the nonspecific symptoms attributed to the patient's underlying illness. Several therapeutic approaches are being used including both increasing and withdrawing immunosuppression, and the use of cellular therapies. Unfortunately, the success rate of these approaches is low and the mortality of this complication is very high. New approaches are needed. We report on three cases of GvHD developing after solid organ transplantation treated with ruxolitinib.

Donor-targeted serotherapy as a rescue therapy for steroid-resistant acute GVHD after HLA-mismatched kidney transplantation

“…Ruxolitinib, a Janus kinase inhibitor, has recently emerged as a promising treatment for steroid‐refractory acute GVHD . However, experience in SOT‐associated GVHD is mixed and still limited . The bottom line is that immunosuppression escalation increases the risk of lethal infections .…”

Complete resolution of a cutaneous grade 2 graft‐versus‐host disease after liver transplantation using ruxolitinib

“…The activity of therapeutic JAK 1/2 blockade in GvHD has already been reported. 4,5 In our experience, ruxolitinib has exhibited an overall favorable safety profile and appears to be a viable option in treating cutaneous grade 2 GvHD after LT. Nevertheless, synergy between lowered immunosuppression and ruxolitinib cannot be ruled out.…”

“…[1][2][3] We report the complete remission of a cutaneous grade 2 GvHD after LT treated with ruxolitinib, a Janus kinase (JAK)-1/2 inhibitor recently proposed in this field. 4,5 A 30-year-old female with cryptogenic cirrhosis underwent super-urgent ABO-incompatible deceased donor retransplantation for hepatic artery thrombosis. Given the rapid onset, worsening clin-Italy…”

“…While there is no consensus on either ruxolitinib dosage or the length of therapy, experience treating glucocorticoid-refractory acute GvHD after allogeneic stem-cell transplantation, and the results of the REACH2 clinical trial, in which our institution participated, both suggest the dose administered was safe. [5][6][7][8][9] Further studies are, however, necessary to confirm the timing of administration, optimal dosing, and tapering, as well as the benefits of ruxolitinib in the treatment of GvHD in LT recipients.…”

A 14-Year Follow-Up of a Combined Liver-Pancreas-Kidney Transplantation: Case Report and Literature Review

“…GVHD that occurs after solid organ transplantation mainly refers to: T lymphocytes present in the donor liver are activated after entering the recipient, and then cloned and expanded to attack the host tissues and organs. It is a serious complication after solid organ transplantation, with a mortality rate of more than 85% (11). The most commonly used diagnostic criteria for GVHD after solid organ transplantation are the threepoint diagnostic criteria: patients with characteristic clinical symptoms and signs such as rash, fever, and diarrhea; the pathological examination and microbial culture of the involved and organs; evidence of donor lymphocytes found in peripheral blood or affected organs, such as the detection of donor lymphocyte DNA or HLA (12).…”