title: Efficacy and safety of intra-arterial steroid infusions in patients with steroid-resistant gastrointestinal acute graft-versus-host disease.
abstract: There is no established second-line treatment for steroid-resistant acute graft-versus-host disease (GVHD). We prospectively assessed the safety and efficacy of intra-arterial steroid infusions (IASIs) for steroid-resistant acute gastrointestinal (GI) GVHD and compared the outcomes with those of historical controls at our institution. Nineteen consecutive, allogeneic hematopoietic stem cell transplantation subjects aged 31-67 years (median 52) were enrolled between October, 2008, and November, 2012. Acute GVHD was confirmed by biopsy in all cases. The enrolled patients were treated with infusions of methylprednisolone into the mesenteric arteries and/or gastroduodenal and left gastric arteries. Fourteen consecutive patients who developed steroid-resistant acute GI GVHD between 2001 and 2008 were used as controls. For the primary endpoint at day 28, the overall and complete responses in the IASI group trended higher (79% vs. 42%, p = 0.066) and were significantly higher (63% vs. 21%, p = 0.033) than those in the control group. Although not statistically significant, owing to the small population, the crude day-180-nonrelapse mortality rate was about 20% lower and the day-180-overall-survival rate tended to be higher than the control (11% vs. 29%, p = 0.222; 79% vs. 50%, p = 0.109, respectively). There were no serious IASI-related complications. Our results suggest that IASI can safely provide excellent efficacy for refractory acute GI GVHD without increasing infection-related complications and may improve prognosis.
authors: Hematology, Graduate School of Medicine, Osaka City University, Osaka, Japan.
authors: Mitsutaka
authors: M
authors: Nishimoto
authors: Hematology, Graduate School of Medicine, Osaka City University, Osaka, Japan. Electronic address: hide_koh@med.osaka-cu.ac.jp.
authors: Hideo
authors: H
authors: Koh
authors: Hematology, Graduate School of Medicine, Osaka City University, Osaka, Japan.
authors: Asao
authors: A
authors: Hirose
authors: Hematology, Graduate School of Medicine, Osaka City University, Osaka, Japan.
authors: Mika
authors: M
authors: Nakamae
authors: Hematology, Graduate School of Medicine, Osaka City University, Osaka, Japan.
authors: Takahiko
authors: T
authors: Nakane
authors: Hematology, Graduate School of Medicine, Osaka City University, Osaka, Japan.
authors: Yoshiki
authors: Y
authors: Hayashi
authors: Hematology, Graduate School of Medicine, Osaka City University, Osaka, Japan.
authors: Hiroshi
authors: H
authors: Okamura
authors: Hematology, Graduate School of Medicine, Osaka City University, Osaka, Japan.
authors: Takuro
authors: T
authors: Yoshimura
authors: Hematology, Graduate School of Medicine, Osaka City University, Osaka, Japan.
authors: Shiro
authors: S
authors: Koh
authors: Hematology, Graduate School of Medicine, Osaka City University, Osaka, Japan.
authors: Satoru
authors: S
authors: Nanno
authors: Hematology, Graduate School of Medicine, Osaka City University, Osaka, Japan.
authors: Yasuhiro
authors: Y
authors: Nakashima
authors: Department of Radiology, Graduate School of Medicine, Osaka City University, Osaka, Japan.
authors: Toru
authors: T
authors: Takeshita
authors: Department of Radiology, Graduate School of Medicine, Osaka City University, Osaka, Japan.
authors: Akira
authors: A
authors: Yamamoto
authors: Department of Radiology, Graduate School of Medicine, Osaka City University, Osaka, Japan.
authors: Yukimasa
authors: Y
authors: Sakai
authors: Department of Radiology, Graduate School of Medicine, Osaka City University, Osaka, Japan.
authors: Norifumi
authors: N
authors: Nishida
authors: Department of Radiology, Graduate School of Medicine, Osaka City University, Osaka, Japan.
authors: Toshiyuki
authors: T
authors: Matsuoka
authors: Department of Radiology, Graduate School of Medicine, Osaka City University, Osaka, Japan.
authors: Yukio
authors: Y
authors: Miki
authors: Hematology, Graduate School of Medicine, Osaka City University, Osaka, Japan.
authors: Masayuki
authors: M
authors: Hino
authors: Hematology, Graduate School of Medicine, Osaka City University, Osaka, Japan.
authors: Hirohisa
authors: H
authors: Nakamae
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D018572:Disease-Free Survival; D004351:Drug Resistance; D005260:Female; D005767:Gastrointestinal Diseases / Q000188:drug therapy / Q000401:mortality; D006086:Graft vs Host Disease / Q000188:drug therapy / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013256:Steroids / Q000008:administration & dosage*; D015996:Survival Rate; D013997:Time Factors
chemical_list: D013256:Steroids