Intra-mesenteric steroids for steroid-refractory graft-versus-host disease in pediatric patients: A safe option
Introduction. Graft-versus-host disease is a serious complication after hematopoietic stem cell transplantation and is a major cause of death post-transplantation. Approximately 50% of acute graft-versus-host disease patients do not respond to systemic steroids and their prognosis is poor regardless...
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Instituto Nacional de Salud
2024-12-01
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| Series: | Biomédica: revista del Instituto Nacional de Salud |
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| Online Access: | https://revistabiomedica.org/index.php/biomedica/article/view/7394 |
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| author | Ana M. Aristizábal Lina P. Montaña Jaiber Gutiérrez Diego Medina Alexis A. Franco Eliana Manzi Ángela Devia Zapata Walter Mosquera |
| author_facet | Ana M. Aristizábal Lina P. Montaña Jaiber Gutiérrez Diego Medina Alexis A. Franco Eliana Manzi Ángela Devia Zapata Walter Mosquera |
| author_sort | Ana M. Aristizábal |
| collection | DOAJ |
| description | Introduction. Graft-versus-host disease is a serious complication after hematopoietic stem cell transplantation and is a major cause of death post-transplantation. Approximately 50% of acute graft-versus-host disease patients do not respond to systemic steroids and their prognosis is poor regardless of the treatment. This study describes our experience with pediatric patients diagnosed with steroid-refractory graft-versus-host disease who received intra-mesenteric steroid treatment.
Objective. To determine the outcomes of intra-mesenteric steroid use in the management of pediatric patients diagnosed with refractory graft-versus-host disease.
Materials and methods. The study included patients under 18 years old with allogeneic hematopoietic stem cell transplantation who underwent intra-mesenteric steroid injection for resistant gastrointestinal graft-versus-host disease between January, 2016, and December, 2021. Methylprednisolone was administered via intra-arterial injection through the celiac trunk and the superior and inferior mesenteric arteries.
Results. We collected data on 21 patients: nine (90%) responded with a subjective decrease in fecal output and a reduction in bilirubin and transaminases. Seven patients required a second intra-mesenteric injection and presented a complete response in 85% of the cases. Only one patient experienced local complications after the procedure. Twelve patients (57%) died with one death due to acute graft-versus-host disease.
Conclusion. Reports in the adult population have shown an approximately 50% response rate with few complications, making it a second-line management standard. As far as we know, this is the largest pediatric cohort reported in Latin America. Our findings suggest that intra-mesenteric steroid administration for managing hepatic and gastrointestinal graftversus-host disease may be considered an early adjuvant treatment in patients with steroidrefractory graft-versus-host disease. |
| format | Article |
| id | doaj-art-5a30835df33c402cbaf7dee7a4549eed |
| institution | Kabale University |
| issn | 0120-4157 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | Instituto Nacional de Salud |
| record_format | Article |
| series | Biomédica: revista del Instituto Nacional de Salud |
| spelling | doaj-art-5a30835df33c402cbaf7dee7a4549eed2025-01-21T18:56:11ZengInstituto Nacional de SaludBiomédica: revista del Instituto Nacional de Salud0120-41572024-12-0144Sp. 2637110.7705/biomedica.73948849Intra-mesenteric steroids for steroid-refractory graft-versus-host disease in pediatric patients: A safe optionAna M. Aristizábal0https://orcid.org/0000-0002-2234-5152Lina P. Montaña1https://orcid.org/0000-0002-0723-8842Jaiber Gutiérrez2https://orcid.org/0000-0002-0550-0923Diego Medina3https://orcid.org/0000-0002-1465-7957Alexis A. Franco4https://orcid.org/0000-0002-3173-6059Eliana Manzi5https://orcid.org/0000-0001-5577-970XÁngela Devia Zapata6https://orcid.org/0000-0003-1845-9082Walter Mosquera7https://orcid.org/0000-0002-4010-2103Servicio de Cardiología Pediátrica, Departamento Materno-Infantil, Fundación Valle del Lili, Cali, Colombia; Facultad de Ciencias de la Salud, Universidad Icesi, Cali, ColombiaServicio de Cardiología Pediátrica, Departamento Materno-Infantil, Fundación Valle del Lili, Cali, Colombia; Facultad de Ciencias de la Salud, Universidad Icesi, Cali, ColombiaServicio de Cardiología Pediátrica, Departamento Materno-Infantil, Fundación Valle del Lili, Cali, Colombia; Facultad de Ciencias de la Salud, Universidad Icesi, Cali, ColombiaFacultad de Ciencias de la Salud, Universidad Icesi, Cali, Colombia; Unidad de Trasplante de Médula Ósea, Servicio de Hematoncología Pediátrica, Departamento Materno-Infantil, Fundación Valle del Lili, Cali, ColombiaFacultad de Ciencias de la Salud, Universidad Icesi, Cali, Colombia; Unidad de Trasplante de Médula Ósea, Servicio de Hematoncología Pediátrica, Departamento Materno-Infantil, Fundación Valle del Lili, Cali, ColombiaFacultad de Ciencias de la Salud, Universidad Icesi, Cali, Colombia; Centro de Investigaciones Clínicas, Fundación Valle del Lili, Cali, ColombiaCentro de Investigaciones Clínicas, Fundación Valle del Lili, Cali, ColombiaServicio de Cardiología Pediátrica, Departamento Materno-Infantil, Fundación Valle del Lili, Cali, Colombia; Facultad de Ciencias de la Salud, Universidad Icesi, Cali, ColombiaIntroduction. Graft-versus-host disease is a serious complication after hematopoietic stem cell transplantation and is a major cause of death post-transplantation. Approximately 50% of acute graft-versus-host disease patients do not respond to systemic steroids and their prognosis is poor regardless of the treatment. This study describes our experience with pediatric patients diagnosed with steroid-refractory graft-versus-host disease who received intra-mesenteric steroid treatment. Objective. To determine the outcomes of intra-mesenteric steroid use in the management of pediatric patients diagnosed with refractory graft-versus-host disease. Materials and methods. The study included patients under 18 years old with allogeneic hematopoietic stem cell transplantation who underwent intra-mesenteric steroid injection for resistant gastrointestinal graft-versus-host disease between January, 2016, and December, 2021. Methylprednisolone was administered via intra-arterial injection through the celiac trunk and the superior and inferior mesenteric arteries. Results. We collected data on 21 patients: nine (90%) responded with a subjective decrease in fecal output and a reduction in bilirubin and transaminases. Seven patients required a second intra-mesenteric injection and presented a complete response in 85% of the cases. Only one patient experienced local complications after the procedure. Twelve patients (57%) died with one death due to acute graft-versus-host disease. Conclusion. Reports in the adult population have shown an approximately 50% response rate with few complications, making it a second-line management standard. As far as we know, this is the largest pediatric cohort reported in Latin America. Our findings suggest that intra-mesenteric steroid administration for managing hepatic and gastrointestinal graftversus-host disease may be considered an early adjuvant treatment in patients with steroidrefractory graft-versus-host disease.https://revistabiomedica.org/index.php/biomedica/article/view/7394graft-versus-host diseasesteroidsinjectionsintra-arterialbone marrow transplantationpediatrics |
| spellingShingle | Ana M. Aristizábal Lina P. Montaña Jaiber Gutiérrez Diego Medina Alexis A. Franco Eliana Manzi Ángela Devia Zapata Walter Mosquera Intra-mesenteric steroids for steroid-refractory graft-versus-host disease in pediatric patients: A safe option Biomédica: revista del Instituto Nacional de Salud graft-versus-host disease steroids injections intra-arterial bone marrow transplantation pediatrics |
| title | Intra-mesenteric steroids for steroid-refractory graft-versus-host disease in pediatric patients: A safe option |
| title_full | Intra-mesenteric steroids for steroid-refractory graft-versus-host disease in pediatric patients: A safe option |
| title_fullStr | Intra-mesenteric steroids for steroid-refractory graft-versus-host disease in pediatric patients: A safe option |
| title_full_unstemmed | Intra-mesenteric steroids for steroid-refractory graft-versus-host disease in pediatric patients: A safe option |
| title_short | Intra-mesenteric steroids for steroid-refractory graft-versus-host disease in pediatric patients: A safe option |
| title_sort | intra mesenteric steroids for steroid refractory graft versus host disease in pediatric patients a safe option |
| topic | graft-versus-host disease steroids injections intra-arterial bone marrow transplantation pediatrics |
| url | https://revistabiomedica.org/index.php/biomedica/article/view/7394 |
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