Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Graft-Versus-Host Disease

Steroid myopathy in patients with acute graft-versus-host disease treated with high-dose steroid therapy

Bone Marrow Transplantation volume 38, pages 299–303 (2006)Cite this article

Abstract

High-dose steroids are the first line of treatment for acute graft-versus-host disease (aGVHD). Steroid myopathy is a debilitating steroid-induced complication that significantly impairs a patient's performance status. To determine the frequency and severity of steroid myopathy and other steroid related complications in patients with acute myeloid leukemia (AML)/myelodysplastic syndrome (MDS) who developed grade ⩾2 aGVHD after allogeneic hematopoietic stem cell transplantation (HSCT), we performed a retrospective analysis. Patients were included in the analysis if they had a diagnosis of AML/MDS, underwent an allogeneic HSCT between January 1996 and December 2001 and developed grade ⩾2 aGVHD that was treated with 2 mg/kg of methylprednisolone and survived at least 100 days post transplant. A total of 70 patients fulfilled our inclusion criteria. Steroid myopathy was identified in 29 (41%) patients. Steroid myopathy was generally of moderate severity with severe debilitating steroid myopathy seen in only 3% of patients. We concluded that steroid myopathy is a common complication of high-dose steroid therapy after allogeneic HSCT in AML/MDS. Interventions aimed at preventing and treating this complication are warranted and need to be explored in prospective clinical trials.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Similar content being viewed by others

References

  1. Thomas ED . Karnofsky Memorial Lecture. Marrow transplantation for malignant diseases. J Clin Oncol 1983; 1: 517–531.

    Article  CAS  PubMed  Google Scholar 

  2. Antin JH, Ferrara J . Cytokine dysregulation and acute graft-versus-host disease. Blood 1992; 80: 2964–2968.

    CAS  PubMed  Google Scholar 

  3. Ferrara J, Deeg HJ . Graft versus host disease. N Engl J Med 1991; 324: 667–674.

    Article  CAS  PubMed  Google Scholar 

  4. Chao NJ, Schmidt GM, Niland JC, Amylon MD, Dagis AC, Long GD et al. Cyclosporine, methotrexate, and prednisone Compared with cyclosporine and prednisone for prophylaxis of acute graft-versus-host disease. N Engl J Med 1993; 329: 1225–1230.

    Article  CAS  PubMed  Google Scholar 

  5. Martin PJ, Schoch G, Fisher L, Byers V, Anasetti C, Appelbaum FR et al. A retrospective analysis of therapy for acute graft versus-host disease: initial treatment. Blood 1990; 76: 1464–1472.

    CAS  PubMed  Google Scholar 

  6. Ruutu T, Hermans J, van Biezen A, Niederwieser D, Gratwohl A, Apperley JF . How should corticosteroids be used in the treatment of acute GVHD? EBMT Chronic Leukemia Working Party. European Group for Blood and Marrow Transplantation. Bone Marrow Transplant 1998; 22: 614–615.

    Article  CAS  PubMed  Google Scholar 

  7. Ruutu T, Niederwieser D, Gratwohl A, Apperley JF . A survey of the prophylaxis and treatment of acute GVHD in Europe: a report of the European Group for Blood and Marrow, Transplantation (EBMT). Chronic Leukaemia Working Party of the EBMT. Bone Marrow Transplant 1997; 19: 759–764.

    Article  CAS  PubMed  Google Scholar 

  8. Cushing H . The basophil adenomas of the pituitary body and their clinical manifestation. Johns Hopkins Med J 1932; 50: 137.

    Google Scholar 

  9. Batchelor TT, Taylor LP, Thaler HT, Posner JB, DeAngelis LM . Steroid myopathy in cancer patients. Neurology 1997; 48: 1234–1238.

    Article  CAS  PubMed  Google Scholar 

  10. Afifi AK, Bergman RA, Harvey JC . Steroid myopathy. Clinical, histologic and cytologic observations. Johns Hopkins Med J 1968; 123: 158–173.

    CAS  PubMed  Google Scholar 

  11. Heinemann AW, Linacre JM, Wright BD, Hamilton BB, Granger C . Prediction of rehabilitation outcomes with disability measures. Arch Phys Med Rehabil 1994; 75: 133–143.

    Article  CAS  PubMed  Google Scholar 

  12. Kendall FP, McCreary EK, Provance PG . Muscles: Testing and Function, 4th edn. Williams & Wilkins: Baltimore, 1993.

    Google Scholar 

  13. Linacre JM, Heinemann AW, Wright BD, Granger CV, Hamilton BB . The structure and stability of the Functional Independence Measure. Arch Phys Med Rehabil 1994; 75: 127–132.

    CAS  PubMed  Google Scholar 

  14. Schacke H, Docke WD, Asadullah K . Mechanisms involved in the side effects of glucocorticoids. Pharmacol Ther 2002; 96: 23–43.

    Article  CAS  PubMed  Google Scholar 

  15. Stuck AE, Minder CE, Frey FJ . Risk of infectious complications in patients taking glucocorticosteroids. Rev Infect Dis 1989; 11: 954–963.

    Article  CAS  PubMed  Google Scholar 

  16. Hings IM, Filipovich AH, Miller WJ, Blazar BL, McGlave PB, Ramsay NK . Prednisone therapy for acute graft-versus host disease: short- versus long-term treatment. A prospective randomized trial. Transplantation 1993; 56: 577–580.

    Article  CAS  PubMed  Google Scholar 

  17. Hamon MD, Gale RF, Macdonald ID, Smith OP, Collis CH, Skeggs DB . Incidence of cataracts after single fraction total body irradiation: the role of steroids and graft versus host disease. Bone Marrow Transplant 1993; 12: 233–236.

    CAS  PubMed  Google Scholar 

  18. Hardie IR, Matsunami C, Hilton A . Ocular complications in renal transplant recipients. Transplant Proc 1992; 24: 177.

    CAS  PubMed  Google Scholar 

  19. Pai RP, Mitchell P, Chow VC . Post-transplant cataract: lesson from kidney–pancreas transplantation. Transplantation 2000; 69: 1108.

    Article  CAS  PubMed  Google Scholar 

  20. Bray LC, Carey PJ, Proctor SJ, Evans RG, Hamilton PJ . Ocular complications of bone marrow transplantation. Br J Ophthalmol 1991; 75: 611–614.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Andrews RC, Walker BR . Glucocorticoids and insulin resistance: old hormones, new targets. Clin Sci (London) 1999; 96: 513–523.

    Article  CAS  Google Scholar 

  22. Ullrich S, Berchtold S, Ranta F, Ris F, Rosler M, Gerlach U et al. Serum- and glucocorticoid-inducible kinase 1 (SGK1) mediates glucocorticoid-induced inhibition of insulin secretion. Diabetes 2005; 54: 1090–1099.

    Article  CAS  PubMed  Google Scholar 

  23. Raul Ariza-Andraca C, Barile-Fabris LA, Frati-Munari AC, Baltazar-Montufar P . Risk factors for steroid diabetes in rheumatic patients. Arch Med Res 1998; 29: 259–262.

    CAS  PubMed  Google Scholar 

  24. Jindal RM, Hjelmesaeth J . Impact and management of posttransplant diabetes mellitus. Transplantation 2000; 70 (Suppl 11): 58.

    Google Scholar 

  25. Shapiro R, Scantlebury VP, Jordan ML . Reversibility of tacrolimus-induced posttransplant diabetes: an illustrative case and review of the literature. Transplant Proc 1997; 10: 760.

    Google Scholar 

  26. Lifton RP, Gharavi AG, Geller DS . Molecular mechanisms of human hypertension. Cell 2001; 104: 545.

    Article  CAS  PubMed  Google Scholar 

  27. Midtvedt KN, Neumayer HH . Management strategies for posttransplant hypertension. Transplantation 1998; 70 (11 Suppl): 64.

    Google Scholar 

  28. Covar RA, Leung DY, McCormick D, Steelman J, Zeitler P, Spahn JD . Risk factors associated with glucocorticoid-induced adverse effects in children with severe asthma. J Allergy Clin Immunol 2000; 59106: 651–656.

    Article  Google Scholar 

  29. Renold AE, Haydar NA, Reddy WJ, Goldfien A, St Marc JR, Laidlaw JC . Biological effects of fluorinated derivatives of hydrocortisone and progesterone in man. Ann NY Acad Sci 1955; 61: 582–590.

    Article  CAS  PubMed  Google Scholar 

  30. Thorn GW, Renold AE, Morse WI, Goldfien A, Reddy WJ . Highly potent adrenal cortical steroids: structure and biologic activity. Ann Intern Med 1955; 43: 979–1000.

    Article  CAS  PubMed  Google Scholar 

  31. Price SR, Du JD, Bailey JL, Mitch WE . Molecular mechanisms regulating protein turnover in muscle. Am J Kidney Dis 2001; 37 (1 Suppl 2): S112–S114.

    Article  CAS  PubMed  Google Scholar 

  32. Khaleeli AA, Edwards RH, Gohil K, McPhail G, Rennie MJ, Round J et al. Corticosteroid myopathy: a clinical and pathological study. Clin Endocrinol (Oxford) 1983; 18: 155–166.

    Article  CAS  Google Scholar 

  33. Bielefeld P . Actualites sur la myopathie cortisonique. La Revue Med Interne 1996; 17: 255.

    Article  CAS  Google Scholar 

  34. Shee CD . Risk factors for hydrocortisone myopathy in acute severe asthma. Respir Med 1990; 84: 229–233.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. University at Buffalo School of Medicine, Buffalo, NY, USA

    H J Lee

  2. Department of Blood and Marrow Transplantation, University of Texas MD Anderson Cancer Center, Houston, TX, USA

    B Oran, R M Saliba, D M Couriel, J Neumann, M de Lima, R Champlin & S Giralt

  3. Department of Palliative Care and Rehabilitation Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA

    K Shin & P Massey

Authors
  1. H J Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. B Oran
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. R M Saliba
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. D M Couriel
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. K Shin
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. P Massey
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. J Neumann
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. M de Lima
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. R Champlin
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. S Giralt
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to S Giralt.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Lee, H., Oran, B., Saliba, R. et al. Steroid myopathy in patients with acute graft-versus-host disease treated with high-dose steroid therapy. Bone Marrow Transplant 38, 299–303 (2006). https://doi.org/10.1038/sj.bmt.1705435

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/sj.bmt.1705435

Keywords

This article is cited by

Search

Advanced search

Quick links