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Managing Inflammatory Manifestations in Patients with Chronic Granulomatous Disease

Pediatric Drugs volume 18, pages 335–345 (2016)Cite this article

Abstract

Chronic granulomatous disease (CGD) is a primary immunodeficiency caused by lack of phagocyte nicotinamide adenine dinucleotide phosphate (NADPH) oxidase, which results in inflammatory dysregulation and increased susceptibility to infections. Patients with CGD may develop severe obstructive disorders of the digestive tract as a result of their dysregulated inflammatory response. Despite a growing focus on inflammatory manifestations in CGD, the literature data on obstructive complications are far less extensive than those on infectious complications. Diagnosis and management of patients with concomitant predispositions to infections and hyperinflammation are particularly challenging. Although the inflammatory and granulomatous manifestations of CGD usually respond rapidly to steroid treatment, second-line therapies (immunosuppressants and biologics) may be required in refractory cases. Indeed, immunosuppressants (such as anti-tumor necrosis factor agents, thalidomide, and anakinra) have shown some efficacy, but the value of this approach is controversial, given the questionable risk-to-benefit ratio and the small numbers of patients treated to date. Significant progress in allogeneic hematopoietic stem cell transplantation (the only curative treatment for CGD) has been made through better supportive care and implementation of improved, reduced-intensity conditioning regimens. Gene therapy may eventually be an option for patients lacking a suitable donor; clinical trials with new, safer vectors are ongoing at a few centers.

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Acknowledgments

The authors thank the pediatric and adult clinical teams at Necker Children’s Hospital (Paris, France), Saint-Antoine Hospital (Paris, France), and Foch Hospital (Suresnes, France). They also thank the patients and families who participated in the cohort studies.

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Affiliations

  1. Biotherapy Department, Necker-Enfants Malades University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France

    Alessandra Magnani

  2. Paris Descartes University, Sorbonne Paris Cité, Imagine Institute, Paris, France

    Alessandra Magnani & Nizar Mahlaoui

  3. French National Reference Center for Primary Immune Deficiencies (CEREDIH), Necker-Enfants Malades University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France

    Nizar Mahlaoui

  4. INSERM UMR 1163, Laboratory of Human Genetics of Infectious Diseases, Necker Branch, Paris, France

    Nizar Mahlaoui

  5. Pediatric Immunohematology and Rheumatology Unit, Necker-Enfants Malades University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France

    Nizar Mahlaoui

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  1. Alessandra Magnani
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Correspondence to Alessandra Magnani or Nizar Mahlaoui.

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Alessandra Magnani and Nizar Mahlaoui declare no conflicts of interest.

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Magnani, A., Mahlaoui, N. Managing Inflammatory Manifestations in Patients with Chronic Granulomatous Disease. Pediatr Drugs 18, 335–345 (2016). https://doi.org/10.1007/s40272-016-0182-4

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Keywords

  • Thalidomide
  • Chronic Granulomatous Disease
  • Anakinra
  • Primary Immunodeficiency
  • Recurrent Aphthous Stomatitis