title: Successful treatment of steroid-refractory hepatitic variant of liver graft-vs-host disease with pulse cyclophosphamide.
abstract: OBJECTIVE
  Corticosteroid-resistant graft-vs-host disease (GVHD) is difficult to manage and is associated with high morbidity and mortality. No standard treatment exists. We have previously seen good results with pulse cyclophosphamide (Cy) in the treatment of liver GVHD in contrast to gastrointestinal GVHD, and here we report results of pulse Cy protocol in the treatment of steroid-refractory hepatitic variant of liver GVHD, with no association to the gut.
  
  
  METHODS
  Cy was infused at a dose of 1,000 mg/m(2). Twenty-nine cyclophosphamide administrations were given to 21 patients. Median time of GVHD onset and Cy administration after transplantation, or donor lymphocyte infusion, were 58 and 69 days, respectively.
  
  
  RESULTS
  Eleven patients (52%) achieved complete remission and 6 patients (29%) achieved partial remission. Four patients (19%) did not respond, however, their condition stabilized and, upon additional therapy, three achieved partial remission and one complete remission. Overall survival of all 21 patients is 86%, with median and maximal follow-up of 33 and 81 months, respectively. Toxicity was mild and easily manageable without influencing chimerism or disease status.
  
  
  CONCLUSIONS
  Pulse Cy seems to be an effective treatment for steroid-refractory hepatitic variant of liver GVHD with a good toxicity profile, which may favor its use instead of drugs with more pronounced immunosuppressive effects.
authors.affiliation: Department of Internal Medicine, Hemato-Oncology, University Hospital Brno and Masaryk University, Brno, Czech Republic. jmayer@fnbrno.cz
authors.forename: Jiri
authors.initials: J
authors.lastname: Mayer
authors.forename: Marta
authors.initials: M
authors.lastname: Krejci
authors.forename: Zdenek
authors.initials: Z
authors.lastname: Pospisil
authors.forename: Michael
authors.initials: M
authors.lastname: Doubek
authors.forename: Andrea
authors.initials: A
authors.lastname: Janikova
authors.forename: Daniela
authors.initials: D
authors.lastname: Zackova
authors.forename: Zdenek
authors.initials: Z
authors.lastname: Racil
authors.forename: Lenka
authors.initials: L
authors.lastname: Smardova
authors.forename: Milan
authors.initials: M
authors.lastname: Navratil
authors.forename: Jan
authors.initials: J
authors.lastname: Kamelander
mesh_terms: D000305:Adrenal Cortex Hormones / Q000494:pharmacology*; D000328:Adult; D003520:Cyclophosphamide / Q000008:administration & dosage* / Q000633:toxicity; D004351:Drug Resistance; D006086:Graft vs Host Disease / Q000188:drug therapy* / Q000401:mortality; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects / Q000401:mortality; D006801:Humans; D008107:Liver Diseases / Q000188:drug therapy / Q000209:etiology*; D008875:Middle Aged; D012074:Remission Induction; D012189:Retrospective Studies; D016879:Salvage Therapy / Q000379:methods*; D016019:Survival Analysis; D018183:Transplantation Chimera; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000305:Adrenal Cortex Hormones; D003520:Cyclophosphamide