title: Intra-arterial catheter guided steroid administration for the treatment of steroid-refractory intestinal GvHD.
abstract: BACKGROUND
  Acute gastrointestinal GvHD (GI-aGvHD) refractory to first-line treatment with systemic corticosteroids is resulting in death in the majority of patients. We prospectively assessed the feasibility and efficacy of regional intra-arterial steroid treatment in adult patients with severe (≥ grade III) GI-aGvHD not responding to first-line treatment.
  
  
  METHODS
  Patients with more than +++ GI-aGvHD not responding to intravenous methylprednisolone at a dose of 2mg/kg/day were eligible for inclusion. Catheter guided intra-arterial steroid administration (IASA) was performed into the superior and inferior mesenteric artery.
  
  
  RESULTS
  12 consecutive patients with steroid-refractory grade III GI-aGvHD received IASA as second-line treatment. 83% of patients had gastrointestinal response including four patients (33%) with complete response at 28 days after IASA. 5/12 patients were alive at a median time of 531 days.
  
  
  CONCLUSIONS
  Regional treatment of severe GVHD with IASA treatment seems to be a safe and effective second-line treatment for steroid-refractory GI-aGvHD in adult patients.
authors.affiliation: Clinic of Radiology and Nuclear Medicine, University Hospital Basel, Switzerland.
authors.forename: David
authors.initials: D
authors.lastname: Bürgler
authors.affiliation: Stem Cell Transplant Team, Division of Hematology, University Hospital Basel, Switzerland. Electronic address: medingerm@uhbs.ch.
authors.forename: Michael
authors.initials: M
authors.lastname: Medinger
authors.affiliation: Stem Cell Transplant Team, Division of Hematology, University Hospital Basel, Switzerland.
authors.forename: Jakob
authors.initials: J
authors.lastname: Passweg
authors.affiliation: Clinic of Radiology and Nuclear Medicine, University Hospital Basel, Switzerland.
authors.forename: Arne
authors.initials: A
authors.lastname: Fischmann
authors.affiliation: Stem Cell Transplant Team, Division of Hematology, University Hospital Basel, Switzerland.
authors.forename: Christoph
authors.initials: C
authors.lastname: Bucher
mesh_terms: D000328:Adult; D000368:Aged; D005240:Feasibility Studies; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage*; D006086:Graft vs Host Disease / Q000188:drug therapy* / Q000209:etiology; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects; D006801:Humans; D007261:Infusions, Intra-Arterial; D007410:Intestinal Diseases / Q000188:drug therapy*; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage*; D008875:Middle Aged; D012074:Remission Induction; D017211:Treatment Failure; D016896:Treatment Outcome; D062666:Vascular Access Devices
chemical_list: D005938:Glucocorticoids; D008775:Methylprednisolone
keywords: Angiography; Corticosteroids; Graft-versus-host disease; Intra-arterial therapy