Introduction: Graft-versus-host disease (GVHD) is a major complication of allogeneic bone marrow transplantation (BMT), resulting in death in the majority of steroid-resistant patients.

In the past 15 years, we revolutionized the use of interventional radiology procedures in the field of stem cell transplantation. This study was aimed to assess the efficacy of regional intra-arterial steroid (IAS) treatment in the largest published cohort of patients with resistant/dependent hepatic and/or gastrointestinal (GI) GVHD. In total, 113 patients with steroid resistant or dependent grade 3-4 hepatic (n = 21), gastrointestinal (GI) (n = 62) GVHD or both (n = 30) were given intra-arterial treatment.

Patients and methods: Patients with liver GVHD received IAS in hepatic artery and patients with gastrointestinal GVHD received IAS in the superior and inferior mesenteric as well as the internal iliac arteries. Patients with pronounced upper GI symptoms also received IAS to the gastroduodenal artery. In total 148 procedures were carried out (range 1-3 per patient).

Results: Partial responses were observed in 33 out of 51 (65%) patients with hepatic GVHD, out of which (55%) had complete response. Median time to complete response was 45 days (range - 5 to 300 days).

For GI GVHD complete responses were observed in 69 out of 92 (75%) and partial responses were observed in 76 out of 92 (83%). The median time to complete response was 20 days (range - 3 to 200 days ).

As this is the largest published cohort of regional IAS therapy for GVHD, multivariate and univariate analysis was done in order to identify the patients with highest chance of response.

Conclusions: Regional treatment of severe GVHD with IAS treatment is effective and safe. GI treatment is more effective than intrahepatic treatment. Early administration of isolated intra-arterial therapy in high-risk patients may further improve the outcome and reduce untoward effects of prolonged systemic immunosuppressive treatment.

Figure 1.
Figure 1.
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Figure 2.
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Disclosures

No relevant conflicts of interest to declare.

Topics:
graft-versus-host disease, steroid therapy, steroids, complete remission, partial response, bone marrow transplantation, allogeneic, hematopoietic stem cell transplantation, immunosuppressive agents, upper gastrointestinal tract series, gastroduodenal artery

Author notes

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Asterisk with author names denotes non-ASH members.

© 2016 by The American Society of Hematology
2016
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