Clinic of Radiology and Nuclear Medicine, University Hospital Basel, Switzerland.
Stem Cell Transplant Team, Division of Hematology, University Hospital Basel, Switzerland.
Leuk Res. 2014 Feb;38(2):184-7. doi: 10.1016/j.leukres.2013.10.024. Epub 2013 Nov 5.
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.
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.
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.
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.
对一线治疗全身性皮质类固醇治疗无反应的急性胃肠道移植物抗宿主病（GI-aGvHD）导致大多数患者死亡。我们前瞻性评估了区域动脉内类固醇治疗对一线治疗无反应的严重（≥III 级）GI-aGvHD 成年患者的可行性和疗效。
对静脉注射甲泼尼龙剂量为 2mg/kg/天且反应不佳的+++以上 GI-aGvHD 患者有资格入组。经导管引导将类固醇（IASA）注入肠系膜上动脉和肠系膜下动脉。
12 例对类固醇耐药的 III 级 GI-aGvHD 患者接受 IASA 作为二线治疗。83%的患者有胃肠道反应，包括 4 例患者（33%）在 IASA 后 28 天完全缓解。5/12 例患者在中位时间 531 天后存活。
IASA 治疗严重的 GVHD 的区域治疗似乎是成年患者对类固醇耐药的 GI-aGvHD 的一种安全有效的二线治疗方法。
