Skip to main content

Advertisement

SpringerLink
Log in

Vedolizumab therapy for pediatric steroid-refractory gastrointestinal acute graft-versus-host disease

  • Case Report
  • Published:
International Journal of Hematology Aims and scope Submit manuscript

Abstract

Vedolizumab, an immunosuppressive drug that acts locally on the gastrointestinal tract, is mainly used for the treatment of inflammatory bowel disease, and has been reported to be effective against gastrointestinal acute graft-versus-host disease (GI-aGVHD) in adults. However, there is insufficient evidence for pediatric GI-aGVHD. We used vedolizumab to treat three cases of GI-aGVHD in patients aged 1.5–4.4 years. It was significantly effective in two patients and did not cause serious side effects in any patient. Vedolizumab might be effective and safe for pediatric GI-aGVHD refractory to other treatments, but this must be confirmed in future studies.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Abbreviations

aGVHD:

Acute graft-versus-host disease

GI:

Gastrointestinal

TNF:

Tumor necrosis factor

IBD:

Inflammatory bowel disease

BMT:

Bone marrow transplantation

MTX:

Methotrexate

TBI:

Total body irradiation

ATG:

Anti-thymocyte globulin

mPSL:

Methylprednisolone

NF-κB:

Nuclear factor-κB

NEMO:

NF-κB essential modulator

PSL:

Prednisolone

BUD:

Budesonide

SCN:

Severe congenital neutropenia

MMF:

Mycophenolate mofetil

References

  1. Feagan BG, Rutgeerts P, Sands BE, Hanauer S, Colombel JF, Sandborn WJ, et al. Vedolizumab as induction and maintenance therapy for ulcerative colitis. N Engl J Med. 2013;369:699–710.

    Article  CAS  Google Scholar 

  2. Sandborn WJ, Feagan BG, Rutgeerts P, Hanauer S, Colombel JF, Sands BE, et al. Vedolizumab as induction and maintenance therapy for Crohn’s disease. N Engl J Med. 2013;369:711–21.

    Article  CAS  Google Scholar 

  3. Fløisand Y, Lazarevic VL, Maertens J, Mattsson J, Shah NN, Zachée P, et al. Safety and effectiveness of vedolizumab in patients with steroid-refractory gastrointestinal acute graft-versus-host disease: a retrospective record review. Biol Blood Marrow Transplant. 2019;25:720–7.

    Article  Google Scholar 

  4. Danylesko I, Bukauskas A, Paulson M, Peceliunas V, Gedde-Dahl DYT, Shimoni A, et al. Anti-α4β7 integrin monoclonal antibody (vedolizumab) for the treatment of steroid-resistant severe intestinal acute graft-versus-host disease. Bone Marrow Transplant. 2019;54:987–93.

    Article  CAS  Google Scholar 

  5. Turner D, Ruemmele FM, Orlanski-Meyer E, Griffiths AM, Carpi JM, et al. Management of paediatric ulcerative colitis, part 1: ambulatory care—an evidence-based guideline from European Crohn’s and colitis organization and European society of paediatric gastroenterology, hepatology and nutrition. J Pediat Gastroenterol Nutr. 2018;67:257–91.

    Article  Google Scholar 

  6. Fløisand Y, Schroeder MA, Chevallier P, Selleslag D, Devine S, et al. A phase 2a randomized clinical trial of intravenous vedolizumab for the treatment of steroid-refractory intestinal acute graft-versus-host disease. Bone Marrow Transplant. 2021;56:2477–88.

    Article  Google Scholar 

  7. Kennedy NA, Goodhand JR, Bewshea C, Nice R, Chee D, Lin S, et al. Anti-SARS-CoV-2 antibody responses are attenuated in patients with IBD treated with infliximab. Gut. 2021. https://doi.org/10.1136/gutjnl-2021-324388.

    Article  PubMed  Google Scholar 

  8. Pai V, Abu-Arja R, Auletta JJ, Rangarajan HG. Successful treatment of steroid-refractory gastrointestinal acute graft-versus-host disease with adjuvant vedolizumab therapy in a pediatric allogeneic stem cell transplant recipient. Pediatr Blood Cancer. 2020;67:2–3.

    Article  Google Scholar 

  9. Ibrahimova A, Davies SM, Lane A, Jordan MB, Lake K, Litts B, et al. α4β7 Integrin expression and blockade in pediatric and young adult gastrointestinal graft-versus-host disease. Pediatr Blood Cancer. 2021. https://doi.org/10.1002/pbc.28968.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Schneider AM, Weghuber D, Hetzer B, Entenmann A, Müller T, Zimmermann G, et al. Vedolizumab use after failure of TNF-α antagonists in children and adolescents with inflammatory bowel disease. BMC Gastroenterol. 2018;18:1–7.

    Article  Google Scholar 

Download references

Acknowledgements

The authors would like to thank the physicians in the Department of Pediatrics, Hiroshima University for the management of patient 3. The authors thank the medical editor from the Division of Postgraduate Education and Training at the National Center for Child Health and Development for professionally editing this manuscript.

Funding

This study is funded in part by a research grant from the National Center for Child Health and Development (2020A-1).

Author information

Author notes

  1. Kyohei Isshiki and Takahiro Kamiya have contributed equally to this work.

Authors and Affiliations

  1. Children’s Cancer Center, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, 157-8535, Japan

    Kyohei Isshiki, Tomoo Osumi, Daisuke Tomizawa & Motohiro Kato

  2. Department of Pediatrics, Tokyo Medical and Dental University Hospital, Tokyo, Japan

    Takahiro Kamiya, Akifumi Endo, Kohsuke Imai & Hirokazu Kanegane

  3. Department of Pediatric Surgery, Tokyo Medical and Dental University Hospital, Tokyo, Japan

    Kentaro Okamoto

  4. Division of Immunology, National Center for Child Health and Development, Tokyo, Japan

    Toshinao Kawai

  5. Division of Gastroenterology, National Center for Child Health and Development, Tokyo, Japan

    Katsuhiro Arai

  6. Department of Gastroenterology and Hepatology, Tokyo Medical and Dental University Hospital, Tokyo, Japan

    Kazuo Ohtsuka & Masakazu Nagahori

Authors
  1. Kyohei Isshiki
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Takahiro Kamiya
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Akifumi Endo
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Kentaro Okamoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Tomoo Osumi
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Toshinao Kawai
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Katsuhiro Arai
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Daisuke Tomizawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Kazuo Ohtsuka
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Masakazu Nagahori
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Kohsuke Imai
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Motohiro Kato
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Hirokazu Kanegane
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

MK and HK designed the research; KI, TK, AE, KO, TO, TK, KA, DT, KO, MN, and KI collected data; KI, TK, MK, and HK drafted the paper; all authors discussed the results and commented on the manuscript.

Corresponding author

Correspondence to Motohiro Kato.

Ethics declarations

Conflict of interest

All authors declare no conflicts of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Isshiki, K., Kamiya, T., Endo, A. et al. Vedolizumab therapy for pediatric steroid-refractory gastrointestinal acute graft-versus-host disease. Int J Hematol 115, 590–594 (2022). https://doi.org/10.1007/s12185-021-03245-0

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12185-021-03245-0

Keywords

Search

Navigation