Role of intra-arterial steroid administration in the management of steroid-refractory acute gastrointestinal graft-versus-host disease.
We report here a case of severe steroid-refractory gastrointestinal graft-versus-host disease treated with intra-arterial administration of corticosteroids. A 53-year-old female with non-Hodgkin's lymphoma received peripheral blood hematopoietic stem cell transplant from her HLA-matched sibling. She developed grade II skin and grade IV gastrointestinal graft-versus-host disease with no hepatic involvement. Therapy with oral prednisone easily controlled her skin rash but she had profuse diarrhea that did not respond to high dose intravenous corticosteroids and denileukin diftitox. Infusion of methyl-prednisolone into superior and inferior mesenteric arteries produced dramatic improvement of diarrhea, with complete resolution of gastrointestinal graft-versus-host disease.
Tfayli
Arafat
A
Department of Internal Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA. Arafat-tfayli@ouhsc.edu
Selby
George
G
Maqbool
Feroz
F
Bierbaum
Walter
W
Hamadani
Mehdi
M
D000284:Administration, Oral; D000970:Antineoplastic Agents / Q000008:administration & dosage; D003967:Diarrhea / Q000188:drug therapy / Q000209:etiology / Q000473:pathology; D004167:Diphtheria Toxin / Q000008:administration & dosage; D004351:Drug Resistance / Q000187:drug effects; D005260:Female; D005767:Gastrointestinal Diseases / Q000188:drug therapy* / Q000209:etiology / Q000473:pathology; D005938:Glucocorticoids / Q000008:administration & dosage*; D006086:Graft vs Host Disease / Q000188:drug therapy* / Q000209:etiology / Q000473:pathology; D006801:Humans; D007261:Infusions, Intra-Arterial / Q000379:methods; D007275:Injections, Intravenous / Q000379:methods; D007376:Interleukin-2 / Q000008:administration & dosage; D008224:Lymphoma, Follicular / Q000150:complications / Q000473:pathology / Q000628:therapy*; D008775:Methylprednisolone / Q000008:administration & dosage*; D008875:Middle Aged; D036102:Peripheral Blood Stem Cell Transplantation / Q000009:adverse effects; D011241:Prednisone / Q000008:administration & dosage; D011993:Recombinant Fusion Proteins / Q000008:administration & dosage; D012871:Skin Diseases / Q000188:drug therapy / Q000209:etiology / Q000473:pathology
D000970:Antineoplastic Agents; D004167:Diphtheria Toxin; D005938:Glucocorticoids; D007376:Interleukin-2; D011993:Recombinant Fusion Proteins; C078456:denileukin diftitox; D011241:Prednisone; D008775:Methylprednisolone