Effective use of tocilizumab for the treatment of steroid-refractory gastrointestinal acute graft versus host disease in a child with very high levels of serum interleukin-6

Abstract

Steroid-refractory acute graft versus host disease (SR-aGVHD) is associated with poor prognosis. A three year old male with severe sickle cell disease (SCD) received a 7/8 HLA-matched unrelated bone marrow transplant. He developed grade III acute graft versus host disease (aGVHD) of the gut, which was refractory to methylprednisolone and five other treatment regimens. Due to very high serum Interleukin-6 (IL-6) levels, he received salvage therapy with tocilizumab with resolution of aGVHD. It may be reasonable to further prospectively study routine monitoring of IL-6 levels and the use of tocilizumab in such patients.