Low-dose thoracoabdominal irradiation for the treatment of refractory chronic graft-versus-host disease.
BACKGROUND
Half of the patients with chronic graft-versus-host disease (GvHD) do not achieve a complete remission with first-line therapy. No clear recommendations are available regarding second-line treatments.


METHODS
We retrospectively report our single-center experience of low-dose thoracoabdominal irradiation (1-Gy TAI) in 41 patients with refractory extensive chronic GvHD from 1983 to 2000. Median time from extensive chronic GvHD to TAI was one year (median GvHD episodes before TAI, n = 4).


RESULTS
Eighty-two percent of the patients achieved a clinical response at a median of 34 days after TAI (range, 15-180). Best response rates were observed in fasciitis (79%), and oral GvHD lesions (73%). A complete clinical response was achieved in 11 patients by 2 years postTAI. Fifty-seven percent of the patients had at least a 50% reduction of their corticosteroid daily dose by 6 months postTAI. Probability of corticosteroid discontinuation was 38% by 2 years postTAI (95% CI, 23-56%). Two-year chronic GvHD relapse incidence was 34%. Ten-year survival from irradiation was 57% (95% CI, 42-78%); patients with fasciitis, lymphocytes >1.0 x 10/L, and platelets >200 x 10/L had a better outcome.


CONCLUSIONS
TAI is a safe and efficient option in patients with refractory chronic GvHD, leading to a significant tapering of systemic corticosteroid dose in most cases.
Robin
Marie
M
Bone Marrow Transplantation Unit, Hôpital Saint-Louis, Paris, France.
Guardiola
Philippe
P
Girinsky
Théodore
T
Hernandez
Gabriella
G
Espérou
Hélène
H
Ribaud
Patricia
P
Rocha
Vanderson
V
Garnier
Federico
F
Socié
Gérard
G
Gluckman
Eliane
E
Devergie
Agnès
A
D000005:Abdomen; D000293:Adolescent; D000328:Adult; D002648:Child; D002908:Chronic Disease; D003131:Combined Modality Therapy; D005260:Female; D006086:Graft vs Host Disease / Q000188:drug therapy / Q000532:radiotherapy*; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D011829:Radiation Dosage; D011878:Radiotherapy / Q000009:adverse effects / Q000379:methods*; D012008:Recurrence; D012189:Retrospective Studies; D016019:Survival Analysis; D013909:Thorax; D014184:Transplantation, Homologous
D007166:Immunosuppressive Agents