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
Results
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 peak grade of aGvHD was 3 (range 2 - 4).
The median time from HSCT to onset of GI aGvHD was 20 days (range 6 - 278).
The median time from onset of GI aGvHD to initial IASA was 19 days (range 9 - 41).
7 patients not responding to the first IASA received a second IASA (median period of time between IASA was 13 days,
range 6 - 14).
No technical complications occurred.
There was one duodenal ulcer described in one patient two days after second IASA.
Six out of 12 patients (50%) could be discharged from the hospital at a median of 32 days (15 - 116) post IASA.
Four patients (33%) had a complete response without symptoms.
Two patients (17%) showed a partial response with improved symptoms.
Details are displayed in Table 2.
In the latter,
symptoms decreased from initial GI aGvHD grade of 3 to 1 and 2 respectively (overall aGvHD grade remained between 2 – 3 due to mucocutaneous involvement).
All patients with response were discharged on oral diet and medication.
3 out of 6 responders not responding to initial IASA received a second IASA.
Two complete responders showed improved symptoms thereafter.
One partial responder did not respond to second IASA.
All 6 responders were alive at follow-up 100 days after initial IASA,
2 patients without any symptoms,
2 patients with mild mucocutaneous involvement and 2 patients with mucocutaneous (grade 2) and gastrointestinal (grade 1 – 2) involvement (overall aGvHD grade 2 – 3).
Five of six responders were still alive at a median time of 217 days (64 - 1022) after IASA and 281 days (98 - 1071) after HSCT.
One responder died 560 days after HSCT due to pre-existing comorbidity.
Six out of 12 patients died during hospitalization due to IASA refractory- and steroid refractory GI aGvHD.
All 6 patients not responding to IASA died due to aGvHD related reasons within the hospitalization at a median of time of 40 days (range 17 – 47).