Hematopoietic stem cell transplantation (HSCT) is the standard treatment for high risk leukemia and lymphoma. Acute graft-versus-host disease (aGvHD) is the single most important cause for morbidity and mortality post HSCT. AGvHD is caused by donor T-cells that are activated by host antigen presenting cells, migrate to target tissues (skin, gut, liver) and cause target organ dysfunction. AGvHD with clinically relevant gastrointestinal involvement (GI aGvHD) occurs in 30 – 75% of patients [1]. Standard first line treatment of aGvHD is high dose steroids. However, about...

Patient selection and inclusion criteria Patients were eligible for inclusion if they developed GI aGvHD. All included patients were not responding to intravenous methylprednisolone administered at 2 mg / kg body weight within 14 days after onset of GI aGvHD; and had a GI aGvHD clinical stage of 2 – 4. The diagnosis and severity of aGvHD was graded according to the 1994 consensus conference on acute GvHD grading by Przepiorka et al [1]. An infectious cause of the gastrointestinal symptoms was excluded. Treatment procedure...

Between January 2010 and June 2012, 12 patients with steroid refractory GI aGvHD received IASA at our institution. The mean patient’s age was 53 years (range 30 - 69), 9 were male and 3 female. Underlying diagnosis and patient characteristics are shown in Table 1. All 12 patients showed GI aGvHD with a median grade of 3 (grade 2 - 4), in 6 patients the skin (grade 1 - 3) and in 4 patients the liver (grade 1 - 3) were involved. The median overall...

Catheter guided intraarterial steroid administration (IASA) is a feasible and seems to be an effective second line treatment option for systemic steroid refractory GI aGvHD. GI aGvHD is characterized by both a reduction in the number of steroid receptors in diseased tissue and a decrease in the receptors’ affinity for steroids [6, 7]. Further and higher doses of systemic steroids have failed to improve symptoms of GI aGvHD and furthermore cause profound immunosuppression associated with increased risk of infection and tumor recurrence. IASA delivers treatment...

Przepiorka D, Weisdorf D, Martin P, et al. 1994 consensus conference on acute GVHD grading. Bone Marrow Transplant 1995; 15(6):825 – 828 Weisdorf D, Haake R, Blazar B, Miller W, McGlave P, Ramsay N, Kersey J. & Filipovich A. (1990) Treatment of moderate/severe acute graft-versus-host disease after allogeneic bone marrow transplantation: an analysis of clinical risk features and outcome. Blood, 75, 1024–1030. Pietryga D. (1993) Prevention and treatment of acute graft-vs-host disease. American Journal of Pediatric Hematology and Oncology, 15, 28–48. Shapira MY, Bloom AI,...

David Bürgler1, Christoph Bucher2, Jokob Passweg2, Arne Fischmann1 1Clinic of Radiology & Nuclear Medicine, University of Basel Hospital, Switzerland 2Departmentof Hematology, University of Basel Hospital, Switzerland [email protected]