Oral beclomethasone dipropionate successfully controls gastrointestinal graft-versus-host disease without affecting systemic graft-versus-leukemia effect in blastic phase chronic myeloid leukemia

Abstract

 A 47-year-old man with chronic myeloid leukemia (CML) progressed to blastic crisis (BC) due to poor compliance with imatinib therapy and developed a central nervous system disease during dasatinib therapy. After achieving disease control with chemotherapy, allogeneic bone marrow transplantation was performed followed by whole-brain irradiation. As the patient developed an overlap subtype of chronic graft-versus-host disease (GVHD) affecting mainly the liver and gastrointestinal tract, methylprednisolone at 1mg/kg was started on day 107. However, as the BCR-ABL mRNA level increased on day 121, the steroid dose was decreased. To control gastrointestinal GVHD, oral beclomethasone dipropionate (BDP) at 4mg/day was started on day 173. Digestive tract-related symptoms improved with BDP and the drug was gradually tapered and withdrawn on day 285. The patient has maintained an undetectable BCR-ABL mRNA level. Oral BDP successfully controls gastrointestinal GVHD without affecting systemic graft-versus-leukemia effect and is useful in patients with CML who are resistant to tyrosine kinase inhibitors.