What is the role of alpha-1 antitrypsin in the management of acute graft versus host disease?

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dc.contributor.authorYigenoglu, Tugce Nur
dc.contributor.authorErkurt, Mehmet Ali
dc.contributor.authorDagdas, Simten
dc.contributor.authorUlu, Bahar Uncu
dc.contributor.authorKuku, Irfan
dc.contributor.authorDurdu, Ali
dc.contributor.authorPepeler, Mehmet Sezgin
dc.date.accessioned2026-04-04T13:34:50Z
dc.date.available2026-04-04T13:34:50Z
dc.date.issued2025
dc.departmentİnönü Üniversitesi
dc.description.abstractObjective: Acute graft versus host disease (GVHD) occurs in 20-80 % of patients undergoing allogeneic hematopoietic stem cell transplantation (allo-HSCT). Of these patients, 40 % will be resistant to steroids, which is the standard first-line approach. There is no standard second line treatment approach for patients with steroid refractory acute GVHD (SR-aGVHD). Alpha-1 antitrypsin is a protease inhibitor and has anti-inflammatory and immune regulatory properties. Here we report the outcomes and safety data of 17 patients treated with alpha-1 antitrypsin for SR-aGVHD. Material and methods: Patients who received at least 2 lines of alpha-1 antitrypsin treatment for SR-aGVHD at five transplant centers in T & uuml;rkiye were included in this retrospective study. Results: The median number of alpha-1 antitrypsin treatment line patients received was 4 (range, 2-5). The median time between alpha-1 antitrypsin administration and response was 65 days (range, 10-138 days). Overall response rate was 70.6 %. When the first- and second-month response rates were compared according to GVHD organ involvement, we found that the response rates were similar in skin, liver and gastrointestinal system involvement (p = 0.281 and p = 0.305, respectively). No grade 3-4 anemia, thrombocytopenia or neutropenia was observed after alpha-1 antitrypsin treatment. Two patients had cytomegalovirus infection and 1 patient had pneumonia. At a median follow-up of 7 months, overall survival was 70.6 % and median overall survival was not reached. Conclusion: In conclusion, alpha-1 antitrypsin is an effective and safe treatment option in patients with SRaGVHD, with response rates of up to 70 % in patients with skin, liver and gastrointestinal system involvement. Larger studies are needed to establish a standard second and subsequent treatment approach in patients with SR-aGVHD.
dc.identifier.doi10.1016/j.transci.2024.104057
dc.identifier.issn1473-0502
dc.identifier.issn1878-1683
dc.identifier.issue1
dc.identifier.orcid0000-0003-0901-2043
dc.identifier.orcid0009-0000-2854-0146
dc.identifier.orcid0000-0002-2762-8573
dc.identifier.orcid0000-0001-6872-3780
dc.identifier.orcid0000-0002-6230-9519
dc.identifier.orcid0000-0001-8605-8497
dc.identifier.orcid0000-0002-3285-417X
dc.identifier.pmid39709788
dc.identifier.scopus2-s2.0-85212569794
dc.identifier.scopusqualityQ3
dc.identifier.urihttps://doi.org/10.1016/j.transci.2024.104057
dc.identifier.urihttps://hdl.handle.net/11616/109407
dc.identifier.volume64
dc.identifier.wosWOS:001394004300001
dc.identifier.wosqualityQ4
dc.indekslendigikaynakWeb of Science
dc.indekslendigikaynakScopus
dc.indekslendigikaynakPubMed
dc.language.isoen
dc.publisherPergamon-Elsevier Science Ltd
dc.relation.ispartofTransfusion and Apheresis Science
dc.relation.publicationcategoryMakale - Uluslararası Hakemli Dergi - Kurum Öğretim Elemanı
dc.rightsinfo:eu-repo/semantics/openAccess
dc.snmzKA_WOS_20250329
dc.subjectAllogeneic hematopoietic stem cell
dc.subjecttransplantation
dc.subjectGraft vs host disease
dc.subjectAlpha-1 antitrypsin
dc.titleWhat is the role of alpha-1 antitrypsin in the management of acute graft versus host disease?
dc.typeArticle

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