Intra-arterial methylprednisolone infusion in treatment-resistant graft-versus-host disease.
Acute graft-versus-host disease (GVHD) is a potentially fatal complication following allogeneic hematopoietic stem cell transplant. Standard primary therapy for acute GVHD includes systemic steroids, often in combination with other agents. Unfortunately, primary treatment failure is common and carries a high mortality. There is no generally accepted secondary therapy for acute GVHD. Although few data on localized therapy for GVHD have been published, intra-arterial injection of high-dose corticosteroids may be a viable option. We treated 11 patients with steroid-resistant GVHD using a single administration of intra-arterial high-dose methylprednisolone. Three patients (27%) died periprocedurally. Four patients (36%) had a partial response to intra-arterial treatment and were discharged on total parenteral nutrition and oral medication. Four patients (36%) had a complete response and were discharged on oral diet and oral medication. No immediate treatment or procedure-related complications were noted. Twenty-seven percent of patients survived long-term. Our preliminary results suggest that regional intra-arterial treatment of steroid-resistant GVHD is a safe and potentially viable secondary therapy in primary treatment-resistant GVHD.
Weintraub
Joshua L
JL
Department of Vascular and Interventional Radiology, Mount Sinai Medical Center, Klingenstein Pavillion, Room MC, 1176 5th Avenue, New York, NY 10029, USA. Joshua.Weintraub@mssm.edu
Belanger
Adam R
AR
Sung
Chris C
CC
Stangl
P Anondo
PA
Nowakowski
F Scott
FS
Lookstein
Robert L
RL
D000208:Acute Disease; D000328:Adult; D000368:Aged; D004351:Drug Resistance; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage / Q000627:therapeutic use*; D006086:Graft vs Host Disease / Q000188:drug therapy* / Q000401:mortality; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D007261:Infusions, Intra-Arterial; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage / Q000627:therapeutic use*; D008875:Middle Aged; D015996:Survival Rate; D016896:Treatment Outcome
D005938:Glucocorticoids; D008775:Methylprednisolone