Intra-arterial catheter guided steroid administration for the treatment of steroid-refractory intestinal GvHD

Acute gastrointestinal GvHD (GI-aGvHD) refractory to first-line treatment with systemic corticosteroids is resulting in death in the majority of patients. We prospectively assessed the feasibility and efficacy of regional intra-arterial steroid treatment in adult patients with severe (≥ grade III) GI-aGvHD not responding to first-line treatment.

Patients with more than +++ GI-aGvHD not responding to intravenous methylprednisolone at a dose of 2mg/kg/day were eligible for inclusion. Catheter guided intra-arterial steroid administration (IASA) was performed into the superior and inferior mesenteric artery.

12 consecutive patients with steroid-refractory grade III GI-aGvHD received IASA as second-line treatment. 83% of patients had gastrointestinal response including four patients (33%) with complete response at 28 days after IASA. 5/12 patients were alive at a median time of 531 days.

Regional treatment of severe GVHD with IASA treatment seems to be a safe and effective second-line treatment for steroid-refractory GI-aGvHD in adult patients.