Efficacy of octreotide in controlling refractory diarrhea following bone marrow transplantation

We report the use of octreotide in 10 patients with severe diarrhea, refractory to loperamide, following bone marrow transplantation (BMT). Five patients had regime-related toxicity (RRT) and 5 were suffering from acute intestinal graft versus host disease (GvHD). Complete responses were observed for all patients with RRT, with optimal response being observed in the patients with dose escalation to 250 micrograms tds. Only partial responses were observed in the patients with intestinal GvHD. Increased doses of systemically administered cyclosporin-A (CSA) were necessary to maintain therapeutic levels for 2 patients. Octreotide is very effective in controlling RRT diarrhea. It is less effective in the control of GvHD-related diarrhea. CSA levels require close monitoring, whether the drug is administered systemically or orally.