Interventional Radiology: Hope For People With Complications From Bone Marrow
The standard treatment to treat graft-versus-host disease (GVHD) after bone marrow or cord blood transplant is intravenous (IV) steroids that alter the immune response; however, it is not always effective and failure results in very high mortality. In a study released today, 15 patients who failed standard treatment were given a high dose of steroids directly to the affected organ. By delivering the steroids via catheter to the arteries that are supplying the organs affected by GVHD, a much higher, more effective dose can be given because the rest of the body is spared from the steroid's side effects.
"Overall, fewer than 30 percent of patients with steroid-resistant GVHD respond completely or partially to the standard IV treatment, and their chance of living one year is 15 percent or less. This interventional radiology treatment can be life-saving for these people," said Joshua L. Weintraub, M.D., chief of the Division of Vascular and Interventional Radiology at Mount Sinai Medical Center in New York City.
According to Weintraub, there were no immediate drug or procedure-related complications, and the treatment appears to be safe and effective in combating GVHD -- with about 40 percent of the patients showing complete response to the intra-arterial treatment at less than a year follow-up. The study was presented during the Society of Interventional Radiology's 33rd Annual Scientific Meeting in Washington, D.C.
GVHD is a common complication of an allogeneic bone marrow transplant (one using blood-forming cells donated by a family member or unrelated donor) or cord blood transplant. With GVHD, the immune cells from the donated marrow or cord blood (the graft) attack the body of the transplant patient (the host). GVHD, which can be mild to life-threatening, can affect many different parts of the body, particularly the skin, liver and intestines. In this study the affected organs were the liver and small and large bowels.
Studies from the 1990s show that steroid resistance is common - 80 percent of people fail to have a sustained, complete response rate or only have a partial response, which means the immune cells are still attacking the organ to varying degrees. "Until now, there has been no good therapy for steroid-resistant patients with GVHD. This small study -- the first of its kind in the United States--shows a new, viable option; however, larger studies with longer follow-up results are needed," added Weintraub.