Intra-arterial steroid administration in patients with steroid-refractory acute gastrointestinal graft-versus-host disease

Limited number of studies have shown that intra-arterial steroid administration (IASA) into the superior (SMA) and/or inferior mesenteric arteries (IMA) may be a feasible second-line therapy option for patients with steroid-refractory (SR) gastrointestinal (GI) acute graft-versus-host disease (aGvHD). Viktor Berczi from the Department of Radiology, Semmelweis University, Budapest, Hungary, and colleagues retrospectively analyzed the clinical effectiveness of IASA treatment in adult patients with SR GI aGvHD following hematopoietic stem cell transplantation (HSCT). The analysis was published ahead of print in Clinical Radiology.

Patients and methods

• N = 10 consecutive adult patients
• Median age: 42 years; range, 19–61 years
• Patients had ≥ stage II GI aGvHD and were refractory to intravenous methylprednisolone
• All patients received IASA into the SMA and/or IMA
• The severity of aGvHD was determined as the volume of diarrhoea (stages 0-IV), and the Glucksberg grading system before and 12±3 SD, 27±4 and 54±6 days after IASA treatment
• Median follow-up: 65 days (range, 22–370)

Key findings

• GI responses after IASA:
  • Patients responding at 12 days: 6/10
  • Patients responding at 27 days: 8/10
  • Patients responding at 54 days: 6/10
• Complete GI response after IASA:
  • At 12 days: 1/10 patients
  • At 27 days: 4/10 patients
  • At 54 days: 4/10 patients
• Four patients who reached complete resolution of GI aGvHD at day 12 or 27 showed a sustained symptom-free state
• One patient showed only a temporary response
• Five patients died between days 22 and 67

The authors concluded that IASA “is a safe and effective method to treat SR GI aGvHD in patients who have failed to respond to first-line treatment with intravenous steroids.” Further studies are required to assess the efficacy of IASA and to identify possible prognostic factors associated with a successful outcome in this patient population.