2014 年 40 巻 5 号 p. 291-296
Graft-versus-host diseases (GVHD) are the main complications after stem cell transplantations. The use of systemic steroids remains the standard for first-line treatment of such complications despite the severe adverse side effects such as the risk of opportunistic infections, glucose intolerance, and bone demineralization. Many of the adverse side effects associated with systemic steroids can be avoided through the use of beclomethasone dipropionate (BDP) as BDP is promptly metabolized in the liver after absorption from the intestines. The BDP is an activated form of steroid that exerts a strong anti-inflammatory action and may be expected to have an effect on gastrointestinal GVHD (GI-GVHD).
This retrospective study verified such an effect for 29 cases diagnosed with alimentary GI-GVHD from June 2008 to July 2013 in order to clarify an effective case. The BDP was administered to 21 patients with acute GVHD and 8 patients with chronic GVHD. The GI-GVHD improved in 20 patients and the condition worsened with 9 patients. The BDP was also effective with acute and chronic GI-GVHD. With lighter conditions of the disease at the time of the BDP internal administration, it was more effective. In 15 cases where systemic steroids were administered there were no new infections. It may be concluded that BDP is an effective medication for GI-GVHD when administered at an early stage.