Keywords:
Interventional vascular, Gastrointestinal tract, Haematologic, Catheter arteriography, Outcomes analysis, Catheters, Arterial access
Authors:
D. Bürgler, C. Bucher, J. Passweg, A. Fischmann; Basle/CH
DOI:
10.1594/ecr2013/C-1041
Purpose
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 50% of patients do not fully respond to first line treatment.
Once steroid resistance occurs,
11 – 14% of patients achieve complete remission of aGvHD symptoms [2],
for patients not responding completely mortality is 30 – 70% [3].
Unfortunately,
there is no established second line treatment for steroid refractory aGvHD.
Clinical observation suggests,
that some aGvHD in some patients is amenable to mega dose steroid treatment,
albeit with high treatment related mortality.
Therefore,
the concept of local dose intensification that can easily applied for skin aGvHD has been expanded to GI aGvHD.
Shapira et al.
[4] (in 2002) and Weintraub et al.
[5] (in 2010) described their experience in small uncontrolled single center patient’s series of 11 and 15 patients. However,
the patients described in these reports were mostly pediatric and intraarterial treatment was often administered after multiple other lines of therapy.
Therefore we sought to investigate the applicability of intraarterial steroid administration (IASA) in a setting of adult PBSCT.
We also hypothesized that if IASA were given early after systemic treatment failure,
the response rate would be favorable compared with the published datasets.