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Graft-Versus-Host Disease

Dismal response to high-dose methylprednisolone after failure to respond to standard dose in patients with acute GVHD

Bone Marrow Transplantation volume 45, pages 1749–1753 (2010)Cite this article

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Abstract

Corticosteroids such as methylprednisolone (MP) remain the primary therapy for acute GVHD (aGVHD). Patients who are refractory to standard treatment (MP 2 mg/kg/day) may be treated with high-dose MP. This study evaluated the response to high-dose MP in children with aGVHD refractory to standard dose MP. Children who underwent hematopoietic SCT (HSCT) at our hospital between 1 June 2002 and 31 July 2006 and were treated with high-dose MP upon developing steroid-refractory aGVHD were included. Response to aGVHD therapy, adverse effects attributed to MP and overall outcomes were documented. Ten children received high-dose MP (⩾20 mg/kg/day) on 3–5 consecutive days followed by a tapering dose for steroid-refractory aGVHD, at a median of 12 days after starting standard treatment. Nine patients had ⩾grade III aGVHD. Only one patient with grade III aGVHD had a complete response. Two patients had a partial response but flared when MP was tapered. Complications included hypertension (100%), hyperglycemia requiring insulin therapy (33%) and four documented severe infections. Five children (50%) died (median follow-up: 5.9 years). Salvage therapy other than high-dose MP should be considered in children who fail to respond to MP 2 mg/kg/day.

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Acknowledgements

The authors gratefully acknowledge the clinical care of the patients described in this report provided by the physicians, pharmacists and nurses of the Bone Marrow Transplant Unit, The Hospital for Sick Children, Toronto.

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Authors and Affiliations

  1. Department of Haematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada

    T Schechter, A Gassas, J Doyle & L L Dupuis

  2. Department of Paediatric Hematology/Oncology, Belfast Hospital for Sick Children, Belfast, Ireland

    C Macartney

  3. Department of Clinical Pharmacology and Emergency Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada

    Y Finkelstein

  4. Clinical Pharmacology Unit, Children's Hospital, Boston, MA, USA

    Y Finkelstein

  5. Department of Pediatrics, Allergy and Clinical Immunology Unit, Al-Amiri Hospital, Kuwait City, Kuwait

    M Husain

  6. Department of Pharmacy, The Hospital for Sick Children, Toronto, Ontario, Canada

    L L Dupuis

  7. The Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada

    L L Dupuis

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  1. T Schechter
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  2. C Macartney
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  7. L L Dupuis
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Correspondence to T Schechter.

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Schechter, T., Macartney, C., Finkelstein, Y. et al. Dismal response to high-dose methylprednisolone after failure to respond to standard dose in patients with acute GVHD. Bone Marrow Transplant 45, 1749–1753 (2010). https://doi.org/10.1038/bmt.2010.47

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