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Catheter-Based Steroid Delivery Appears to Halt Severe Cases of Graft-Versus-Host Disease: Presented at SIR By Ed Susman WASHINGTON, DC -- March 19, 2008 -- Delivery of steroids directly to the abdomen through interventional radiological techniques might be able to save critically ill transplant patients suffering from graft-versus-host disease, suggested researchers presenting at the Society of Interventional Radiology (SIR) 33rd Annual Scientific Meeting. "Once a person develops severe graft-versus-host-disease, the mortality rate exceeds 90%," said Joshua Weintraub, MD, Associate Professor of Radiology and Surgery, Mount Sinai Medical Center, New York, New York. "In our pilot study, 46% of the 15 patients with severe graft-versus-host disease achieved a complete response. Another 26.7% of patients made a partial recovery," Dr. Weintraub said in his presentation on March 18. When severe graft-versus-host disease occurs it can affect the liver and other organs in the gut, making eating and digestion difficult, if not impossible, he explained. Patients that had a complete response in his pilot study were able to leave the hospital and to eat on their own. They also received other oral medications. Those who were partially improved were able to leave the hospital but required total parenteral feeding and oral medication. Dr. Weintraub said the patients in the study had received either bone marrow or stem cell transplants. Patients who developed graft-versus-host disease received standard systemic corticosteroids. However, that therapy failed to control the disease in his patients. Therefore, Dr. Weintraub decided to deliver high doses of the corticosteroid directly to the affected organs through catheter-based therapy. Patients with liver disease had the drugs delivered into the hepatic arteries. Those with gastrointestinal disease usually had the drugs delivered via the superior and inferior mesenteric arteries, although 1 patient also had treatments through both internal iliac arteries and another was treated through the celiac axis. Four of the 15 patients died -- 3 from complications of graft-versus-host disease, and 1 from uncontrollable cardiac arrhythmia. There were no immediate complications related to the use of the delivery system or to the doses of drugs delivered. Based on the encouraging results of the exploratory trial, Dr. Weintraub said a larger safety trial will be conducted. The methods used to deliver the drugs are routine for interventional radiologists, commented Joshua Hirsch, MD, Chief of Interventional Neuroradiology, Massachusetts General Hospital, Boston, Massachusetts. "Even though this treatment is at its earliest stages, Dr. Weintraub is getting dramatic results," said Dr. Hirsch, who moderated a press briefing on behalf of the SIR but was not a participant in the study. [Presentation title: Intra-Arterial Steroid Injection Therapy for Systemic Steroid Resistant Graft-Versus-Host Disease. Abstract 187] E-mail this page to a friend or colleague! To print, use this version