Successful Treatment of Refractory Graft Versus Host Disease with
Ruxolitinib in a Child After Autologous Stem Cell Transplantation
Abstract
Autologous hematopoietic stem cell transplantation(AHSCT) is an
increasingly used curative treatment for some solid tumors in children.
Instead of allogeneic transplantation, the risk of developing graft
versus host disease (GvHD) is much lower after AHSCT. Although the
clinical findings of auto-GVHD are mild and self-limited in most cases,
rare cases may be severe and need intensive immunosuppressive treatment.
Here, we present a case who underwent autologous HSCT due to relapsed
neuroblastoma, developed steroid-refractory GvHD after AHSCT, and
achieved remission using ruxolitinib. A 12 years old female patient was
diagnosed with relapsed neuroblastoma. After metaiodobenzylguanidine
treatment, AHSCT was performed, and the status of the disease was a very
good partial response at the time of transplantation. Our patient was
diagnosed with severe and steroid-refractory GvHD with skin involvement
after AHSCT. We used ruxolitinib with extracorporeal photopheresis
because of the essential side effects of the other drugs and got a very
good response. Over the following five months, there was no recurrence
of GvHD. She was in complete remission of neuroblastoma after two years
of AHSCT. It is crucial to keep in mind that GvHD may develop after
AHSCT. Ruxolitinib is an effective treatment for GvHD also after AHSCT.