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Long-Term Use of Oral Beclomethasone Dipropionate for the Treatment of Gastrointestinal Graft-versus-Host Disease

2005; Elsevier BV; Volume: 11; Issue: 8 Linguagem: Inglês

10.1016/j.bbmt.2005.04.008

1523-6536

Renuka Iyer, Theresa Hahn, Hilary N. Roy, Minoo Battiwalla, M. Cooper, Bárbara Anderson, Pam Paplham, Karen Brown, Barbara Bambach, Brahm H. Segal, Philip L. McCarthy,

Childhood Cancer Survivors' Quality of Life

Treatment of severe acute and chronic gastrointestinal (GI) graft-versus-host disease (GVHD) with prolonged high-dose systemic corticosteroids has limited success and considerable toxicity. Beclomethasone dipropionate (BDP) is a potent topically active steroid. We treated 15 patients with acute (n = 2) or chronic (n = 13) GI GVHD refractory to systemic corticosteroids with 28-day courses of oral BDP (2 mg 4 times daily). Response was measured by the change in GI score (sum of 6 GI symptoms) as well as the ability to taper or discontinue systemic corticosteroids. Nine (60%) of 15 evaluable patients responded to BDP, including 3 complete responses (a GI score of 0 or 1 and discontinuation of systemic corticosteroids). Attempts to taper calcineurin inhibitor during BDP therapy were unsuccessful. The 2 patients with acute GVHD had no response to BDP. Responders received a median of 3 cycles (range, 1–20), compared with 1 cycle (range, 1–5) in nonresponders. Suppression of the hypothalamic-adrenal axis was seen in 2 of the 5 patients tested, but neither demonstrated clinically significant symptoms. We conclude that BDP is safe and effective for long-term treatment of chronic GI GVHD. Multiple courses may be necessary to achieve or maintain response in some patients, and prolonged BDP therapy is a feasible alternative to prolonged systemic corticosteroids.