Low-dose thoracoabdominal irradiation for the treatment of refractory chronic graft-versus-host disease.

Abstract

BACKGROUND:

Half of the patients with chronic graft-versus-host disease (GvHD) do not achieve a complete remission with first-line therapy. No clear recommendations are available regarding second-line treatments.

METHODS:

We retrospectively report our single-center experience of low-dose thoracoabdominal irradiation (1-Gy TAI) in 41 patients with refractory extensive chronic GvHD from 1983 to 2000. Median time from extensive chronic GvHD to TAI was one year (median GvHD episodes before TAI, n = 4).

RESULTS:

Eighty-two percent of the patients achieved a clinical response at a median of 34 days after TAI (range, 15-180). Best response rates were observed in fasciitis (79%), and oral GvHD lesions (73%). A complete clinical response was achieved in 11 patients by 2 years postTAI. Fifty-seven percent of the patients had at least a 50% reduction of their corticosteroid daily dose by 6 months postTAI. Probability of corticosteroid discontinuation was 38% by 2 years postTAI (95% CI, 23-56%). Two-year chronic GvHD relapse incidence was 34%. Ten-year survival from irradiation was 57% (95% CI, 42-78%); patients with fasciitis, lymphocytes >1.0 x 10/L, and platelets >200 x 10/L had a better outcome.

CONCLUSIONS:

TAI is a safe and efficient option in patients with refractory chronic GvHD, leading to a significant tapering of systemic corticosteroid dose in most cases.

• Authors: Marie Robin, Philippe Guardiola, Théodore Girinsky, Gabriella Hernandez, Hélène Espérou, Patricia Ribaud, Vanderson Rocha, Federico Garnier, Gérard Socié, Eliane Gluckman, Agnès Devergie
• Journal: Transplantation (Transplantation) Vol. 80 Issue 5 Pg. 634-42 (Sep 15 2005) ISSN: 0041-1337 [Print] United States
• PMID: 16177638 (Publication Type: Journal Article)

Chemical References

• Immunosuppressive Agents

Topics

• Abdomen
• Adolescent
• Adult
• Child
• Chronic Disease
• Combined Modality Therapy
• Female
• Graft vs Host Disease (drug therapy, radiotherapy)
• Hematopoietic Stem Cell Transplantation (adverse effects)
• Humans
• Immunosuppressive Agents (therapeutic use)
• Male
• Middle Aged
• Radiation Dosage
• Radiotherapy (adverse effects, methods)
• Recurrence
• Retrospective Studies
• Survival Analysis
• Thorax
• Transplantation, Homologous