Effectiveness of intra-arterial steroid administration for the treatment of steroid-refractory acute gastrointestinal graft-versus-host disease. Issue 4 (April 2019)

• Record Type: Journal Article
• Authors: Bérczi, V.; Tóth, A.; Tatai, G.; Fábián, J.; Reményi, P.; Masszi, T.
• Is Part Of: Clinical radiology. Volume 74:Issue 4(2019)
• Page Start: 301
• Page End: 305
• Publication Date: 2019-04
• Subjects: Medical radiology -- Periodicals; Radiotherapy -- Periodicals; Radiotherapy -- Periodicals; Radiology -- Periodicals; Societies, Medical -- Periodicals; Medical radiology; Radiotherapy; Electronic journals; Periodicals; 616.0757
• DOI: 10.1016/j.crad.2018.11.013
• Languages: English
• ISSNs: 0009-9260

Abstract

Abstract : AIM: To retrospectively assess the clinical effectiveness of intra-arterial steroid administration (IASA) treatment in adult patients who developed steroid-refractory gastrointestinal acute graft-versus-host disease (GI-aGvHD) (≥stage II) following haematopoietic stem cell transplantation. MATERIALS AND METHODS: Clinical data of 10 consecutive adult patients (age range, 19–61 years; mean age, 42 years) of a single centre with GI-aGvHD (≥stage II) who showed no response to intravenous methylprednisolone and received IASA into the superior (SMA) and/or inferior mesenteric arteries (IMA) were analysed. The severity of aGvHD was determined as the volume of diarrhoea (stages 0–IV) and the Glucksberg grading system before and 12±3 SD, 27±4 and 54±6 days after IASA treatment. Median follow-up was 65 days (range, 22–370 days). RESULTS: Six out of 10 patients at 12 days, 8/10 patients at 27 days, 6/10 patients at 54 days after IASA showed gastrointestinal response. Among them, 1/10 patients at 12 days, 4/10 patients at 27 days, and the same 4/10 patients at 54 days showed complete resolution of GI-aGvHD. The 4/10 patients who reached complete resolution of GI-aGvHD at day 12 or 27 showed a sustained symptom-free state. One in 10 patient showed only a temporary response, 5/10 patients died between days 22 and 67. CONCLUSIONS: IASA seems to be a potentially useful second-line therapy for intravenous steroid-refractory GI-aGvHD. Highlights: Intra-arterial steroid administration has been shown to be effective in reducing the symptoms of acute gastrointestinal GvHD. The successfully treated patients showed long-term symptom-free state. No complications or adverse events were recorded in relationship to the procedure.