Department of Vascular and Interventional Radiology, Mount Sinai Medical Center, Klingenstein Pavillion, Room MC, 1176 5th Avenue, New York, NY 10029, USA.
Cardiovasc Intervent Radiol. 2010 Jun;33(3):509-12. doi: 10.1007/s00270-009-9792-3. Epub 2010 Jan 9.
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.
急性移植物抗宿主病（GVHD）是异基因造血干细胞移植后潜在的致命并发症。急性 GVHD 的标准一线治疗包括全身皮质类固醇，通常与其他药物联合使用。不幸的是，一线治疗失败很常见，死亡率很高。目前尚无公认的急性 GVHD 二线治疗方法。虽然已经发表了一些关于局部治疗 GVHD 的数据，但动脉内注射大剂量皮质类固醇可能是一种可行的选择。我们使用单次动脉内大剂量甲泼尼龙治疗了 11 例类固醇耐药的 GVHD 患者。3 名患者（27%）在围手术期死亡。4 名患者（36%）对动脉内治疗有部分反应，并在全胃肠外营养和口服药物的情况下出院。4 名患者（36%）有完全反应，并在口服饮食和口服药物的情况下出院。没有发现与治疗或手术相关的即时并发症。27%的患者长期存活。我们的初步结果表明，局部动脉内治疗类固醇耐药性 GVHD 是原发性治疗耐药性 GVHD 的一种安全且有潜在可行性的二线治疗方法。
