Shmuel Y. Mahgerefteh MD, Presenter: Nothing to Disclose

Allan I. Bloom MBBCh, Abstract Co-Author: Nothing to Disclose

Dean Nahman MD, Abstract Co-Author: Nothing to Disclose

Nir Sharon, Abstract Co-Author: Nothing to Disclose

Alexander Klimov MD, Abstract Co-Author: Nothing to Disclose

Reuven Or MD, Abstract Co-Author: Nothing to Disclose

Igor Resnik MD, Abstract Co-Author: Nothing to Disclose

Anthony George Verstandig MD, Abstract Co-Author: Nothing to Disclose

Michael Yechiel Shapira MD, Abstract Co-Author: Nothing to Disclose

To prospectively investigate efficacy and safety of adjuvant intra-arterial steroid (AIAS) injection for treatment of steroid-resistant/dependant graft-versus-host-disease (GVHD).

Consecutive patients with steroid-resistant/dependent GVHD treated with AIAS enrolled. Hepatic GVHD treated with intra hepatic arterial infusion of 600 mg/m^2 Methylprednisolone (MP; maximal dose of 1000mg). Gastrointestinal (GI) GVHD  treated with infusion of MP 40-60 mg/vessel into superior and inferior mesenteric arteries, with 40mg of MP to each internal iliac artery or more selectively if possible. Pronounced upper GI symptoms treated with 40 mg MP via gastro-duodenal artery. When GVHD was marked in both liver and GI tract, both organs were treated in the same session. We used non-parametric tests or confidence intervals. Cumulative incidence of time to specific cause of death (COD) was evaluated. Kaplan-Meier survival curves used to estimate times to death or remission.

Fifty-five patients (median age 39.7, range 7.6–69 yrs) with steroid-resistant/dependent GVHD (11 liver, 27 GI, 17 combined) underwent AIAS within a median of 3 weeks from diagnosis. Partial or complete liver and GI response rates were 53.6% and 65.9%, respectively. One year survival was 36%. 21 patients died of GVHD within a year (38%). Other COD: infection (9), disease progression/relapse (3), cystitis (1), other (1). Remission in treated organ was significantly associated with increased survival (liver and GI remission, p<0.01 and p=0.03, respectively). Previous autologous transplant and total body irradiation (TBI) significantly associated with higher one year mortality (p=0.036 and 0.0007, respectively). Survival not associated with age, sex, primary diagnosis, one vs. two organs treated, donor matching, number of transplants, and ablative vs. reduced intensity conditioning (RIC). Eight patients (14.6%) had mild renal failure after IAS (mostly transient), not associated with increased one year mortality.

Our data (largest reported cohort in English literature) suggest that AIAS may be safe, effective treatment for steroid-resistant GVHD. Routine combination of AIAS with standard GVHD treatment should be considered. Further research should show optimal dosing and administration protocol.  

AIAS may be associated with improved patient survival in hepatic or GI steroid-resistant GVHD, an otherwise lethal condition.

Mahgerefteh, S, Bloom, A, Nahman, D, Sharon, N, Klimov, A, Or, R, Resnik, I, Verstandig, A, Shapira, M, Adjuvant Catheter-directed Intra-arterial Organ-specific Immunosuppressive Therapy for Patients with High-grade Steroid-resistant Graft vs Host Disease (GVHD).  Radiological Society of North America 2012 Scientific Assembly and Annual Meeting, November 25 - November 30, 2012 ,Chicago IL. http://archive.rsna.org/2012/12032476.html