Phase II trial of natalizumab with corticosteroids as initial treatment of gastrointestinal acute graft-versus-host disease

Bone Marrow Transplant. 2021 May;56(5):1006-1012. doi: 10.1038/s41409-020-01049-0. Epub 2020 Sep 8.


The α4ß7 integrin is upregulated on naive and memory T cell subsets in patients who subsequently develop gastrointestinal (GI) acute GVHD. Natalizumab (Tysabri®, Biogen Inc.) acts against the α4 subunit that mediates homing of lymphocytes to the GI tract. We initiated a phase II study of natalizumab with corticosteroids for initial treatment of acute GI GVHD. In total, 300 mg IV of natalizumab was given, with steroids initiated up to 3 days prior. Twenty-one subjects were treated, median age was 63 years (range 38-74), and 15 (71%) were male. Eighteen (86%) underwent RIC, 15 (71%) received MUD, and all received PBSCs. Overall GVHD at enrollment was grade II in 4 and grade III in 17. The primary endpoint, day 56 GVHD-free survival rate, was attained in 33.3%. The overall response rate at day 28 and 56 was 57% and 52%, respectively. Six of eight CRs were durable for 1 year. Five experienced toxicity possibly related to natalizumab and ten had infections before day 100. 2-year OS was 43% (95% CI 22-62%) and 2-year NRM was 52% (95% CI 29-71%). Natalizumab with corticosteroids as initial treatment of acute GI GVHD is safe, effective, and durable.

Publication types

  • Clinical Trial, Phase II

MeSH terms

  • Acute Disease
  • Adrenal Cortex Hormones / therapeutic use
  • Adult
  • Aged
  • Female
  • Gastrointestinal Tract
  • Graft vs Host Disease* / drug therapy
  • Hematopoietic Stem Cell Transplantation*
  • Humans
  • Male
  • Middle Aged
  • Natalizumab / adverse effects
  • Transplantation Conditioning


  • Adrenal Cortex Hormones
  • Natalizumab