Dupilumab for Atopic Dermatitis-like Chronic Graft-versus-Host Disease in Three Pediatric Hematopoietic Cell Transplant Recipients

Atopic dermatitis (AD)-like graft-versus-host disease (GVHD) is a chronic form of skin GVHD with features that include erythema, xerosis, scaling, and pruritus. Patients often require treatment with systemic immunosuppression and aggressive topical therapies for relief. Long-term effects of chronic immunosuppression are undesirable and alternative therapies are needed. A retrospective review of 3 patients receiving dupilumab (DUP) for AD-like cGVHD was conducted. Data collected included demographics, transplant history, and GVHD management and outcomes. Information relating to DUP included dose, route, frequency, and safety based on dermatologic reactions, ocular toxicities, and infections. Patients had differing underlying conditions, transplant types, cell sources, and GVHD prophylactic therapies. Three patients received tacrolimus and topical corticosteroids for GVHD treatment, and 1 also received sirolimus and ruxolitinib. After the initial DUP dose, all patients experienced improvement in their GVHD. To date, all patients have complete remission of their skin cGVHD and have weaned off other therapies. No patients experienced dermatologic or ocular toxicities, and no infections were reported. DUP was efficacious and safe for treating AD-like cGVHD in our 3 pediatric patients. Further investigations are warranted to determine the appropriate placement in therapy.