Intra-arterial Methylprednisolone Infusion in Treatment-Resistant Graft-Versus-Host Disease

Weintraub, Joshua; Belanger, Adam R.; Sung, Chris; Stangl, P.A.; Nowakowski, F.; Lookstein, Robert L.

doi:10.1007/s00270-009-9792-3

Cited by 12 publications

(8 citation statements)

References 9 publications

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“…Intra-arterial methylprednisolone has been used in the management of steroid-refractory aGvHD but at present there is insufficient experience to recommend this technique (Weintraub et al, 2010;Milner et al, 2011).…”

Section: Regulatory T-cellsmentioning

confidence: 99%

Diagnosis and management of acute graft‐versus‐host disease

Dignan¹,

et al. 2012

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SummaryA joint working group established by the Haemato-oncology subgroup of the British Committee for Standards in Haematology (BCSH) and the British Society for Bone Marrow Transplantation (BSBMT) has reviewed the available literature and made recommendations for the diagnosis and management of acute graft-versus-host disease. This guideline includes recommendations for the diagnosis and grading of acute graft-versus-host disease as well as primary treatment and options for patients with steroid-refractory disease. The goal of treatment should be effective control of graft-versushost disease while minimizing risk of toxicity and relapse.

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Section: Regulatory T-cellsmentioning

confidence: 99%

Diagnosis and management of acute graft‐versus‐host disease

Dignan¹,

et al. 2012

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“…In comparison of treatment to isolated organ vs combined organ treatments, there was a trend for better gastrointestinal response in the isolated treatments (59.2% vs 34.4% CR; P = 0.059) and there was no statistical significance in the hepatic responses (47.4% vs 25% CR; P = 0.3). Following our previous report on IAS, 4 other groups have used IAS for intestinal GvHD, [33][34][35] all with similar overall response ranging between 36 and 83%, and 33 and 63% CR, but it's use has not been otherwise reported for hepatic GvHD. Interestingly, the intra-arterial approach was used for the treatment of gastrointestinal GvHD with mesenchymal cells 36 and with platelets for gastrointestinal GvHD-associated bleeding.…”

Section: Discussionmentioning

confidence: 99%

“…It is hoped that other centers will include this approach in their standard care algorithm. Our experience is that all those who consulted us in the past, 33,34 are using this method. As is no difference between the original and the modified protocol, and with interest of exempting the use of MTX, our current recommendations for IAS are listed in Table 4.…”

Section: Discussionmentioning

confidence: 99%

Regional intra-arterial steroid treatment in 120 patients with steroid-resistant or -dependent GvHD

Shapira

Klimov

Vipul

et al. 2017

Bone Marrow Transplant

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GvHD results in death in the majority of steroid-resistant patients. This report assesses the safety and efficacy of two regional intra-arterial steroid (IAS) treatment protocols in the largest published cohort of patients with resistant/dependent hepatic and/or gastrointestinal GvHD, as well as identification of predictors of response to IAS and survival. One hundred and twenty patients with hepatic, gastrointestinal GvHD or both were given IAS. Gastrointestinal initial response (IR) and complete response (CR) were documented in 67.9% and 47.6%, respectively, whereas hepatic IR/CR in 54.9% and 33.3%, respectively. The predictors of gastrointestinal CR were lower peak GvHD and steroid-dependent (SD) GvHD. The predictors for hepatic CR were male patient, reduced intensity conditioning and SD GvHD. Twenty-six of the 120 patients (21.6%) are currently alive (median follow-up for the survivors 91.5 months). The 12 months' overall survival is 30% with no treatment-associated deaths. Predictors of 12 months' survival were as follows: first transplant, age<20 years, non-TBI regimen and GvHD CR. Shorter time to gastrointestinal IR but not time to hepatic IR was associated with improved 12 months' survival. IAS appears to be safe and effective. Gastrointestinal treatment is more effective than hepatic treatment. In our study, we conclude our current recommendations for IAS treatment.

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“…In two prospective series, GI GVHD response rates of 70–85% were observed and appeared better than historical controls. [45–47] The need for trained and available interventional radiology specialists may explain the lack of larger and adequately powered randomized studies.…”

Section: Therapeutic Optionsmentioning

confidence: 99%

Therapeutic targets and emerging treatment options in gastrointestinal acute graft-versus-host disease

Renteria

Levine

Ferrara

2016

Expert Opinion on Orphan Drugs

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Introduction Graft-versus-host disease (GVHD) continues to be the major lethal complication of allogeneic hematopoietic stem cell transplantation (HCT) but the standard of care, high dose steroids, has not changed in 40 years. Approximately 50% of GVHD patients will develop steroid refractory disease, typically involving the gastrointestinal (GI) tract, which has a very poor prognosis. Newly developed GVHD biomarker-based risk scores provide the first opportunity to treat patients at the onset of symptoms according to risk of steroid failure. Furthermore, improvements in our understanding of the pathobiology of GVHD, its different signaling pathways, involved cytokines, and the role of post-translational and epigenetic modifications, has identified new therapeutic targets for clinical trials. Areas covered This manuscript summarizes the pathophysiology, diagnosis, staging, current and new targeted therapies for GVHD, with an emphasis on GI GVHD. A literature search on PubMed was undertaken and the most relevant references included. Expert Opinion The standard treatment for GVHD, high dose steroids, offers less than optimal outcomes as well as significant toxicities. Better treatments, especially for GI GVHD, are needed to reduce non-relapse mortality after allogeneic HCT. The identification of high risk patients through a biomarker-defined scoring system offers a personalized approach to a disease that still requires significant research attention.

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Intra-arterial Methylprednisolone Infusion in Treatment-Resistant Graft-Versus-Host Disease

Cited by 12 publications

References 9 publications

Diagnosis and management of acute graft‐versus‐host disease

Diagnosis and management of acute graft‐versus‐host disease

Regional intra-arterial steroid treatment in 120 patients with steroid-resistant or -dependent GvHD

Therapeutic targets and emerging treatment options in gastrointestinal acute graft-versus-host disease

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