Download Slide 1

Intra-arterial Steroid Therapy for
Severe Graft Versus Host
Disease in Bone Marrow and
Stem Cell Transplants
Joshua L. Weintraub, MD
Associate Professor of Radiology & Surgery
Chief, Division of Vascular & Interventional
Radiology
Mount Sinai Medical Center
New York, NY
Graft Versus Host Disease (GVHD)
• Healthy patients have “killer” cell that attack and
destroy foreign invades such as viruses
• The transplant patient’s immune system is
incapable of mounting an effective immune
response
• The patient’s tissues are felt to be “foreign” and
are damaged by the “killer” cells in the transplant
• Damage primarily occurs to the skin, mucous
membranes, biliary ducts, and intestine
Symptoms
• Mild - skin rash
• Moderate – skin rash with gastrointestinal
symptoms including diarrhea
• Severe – skin ulceration, liver dysfunction,
severe diarrhea and protein loss associated with
a high mortality
Graft Versus Host Disease (GVHD)
• Occurring in up to 3060% recipients bone
marrow transplants from
identical sibling stem cell
transplants
• When the donor is a
mismatched sibling or
unrelated donor the rate
increases to 70-90%
Am J Hematol 81:959-962 (2006)
Current Treatments
• Primary therapy is directed at suppressing the
patients immune system with corticosteroids
– Reports from 1990’s indicate that 80% of
responses incomplete or not sustained
• The survival in patients who do not respond to
steroids is around 10%
Weisdorf, D., et al., Blood, 1990.
Intra-arterial Steroid Therapy
• Our study evaluates the delivery of high
concentration of corticosteroids intra-arterially to
the effected organs.
• The potential advantage of this treatment lies in
the fact that direct intra-arterial administration of
steroids may allow significant doses to be
delivered to the area most affected, without
exposing the patient to the deleterious effects of
whole body steroids.
Background
• 15 patients having undergone bone marrow or
stem cell transplantation developed severe
GVHD of the gastrointestinal tract and liver
• Ages 39 to 71
• Failed conventional medical treatment
60 year old with AML
(Acute Myloid Leukemia)
• Bone Marrow
Transplant from
sibling
• Severe GVHD
• Complete response
after single intraarterial treatment with
corticosteroids
Over 60% of our patients responded
• Partial response: 26.7%
– Improved symptoms, discharged on
intravenous feedings
• Complete response: 40 %
– Resolution of symptoms, discharged on
regular diet
Conclusion
Intra-arterial infusion of high dose
corticosteroids shows promise as an
effective and safe treatment for severe
complications of bone marrow and stem
cell transplantation