Details

Autor(en) / Beteiligte

• Turki, Amin T.
• Bayraktar, Evren
• Basu, Oliver
• Benkö, Tamas
• Yi, Ji-Hee
• Kehrmann, Jan
• Tzalavras, Asterios
• Liebregts, Tobias
• Beelen, Dietrich W.
• Steckel, Nina K.

Titel

Ileostomy for steroid-resistant acute graft-versus-host disease of the gastrointestinal tract

Ist Teil von

• Annals of hematology, 2019-10, Vol.98 (10), p.2407-2419

Ort / Verlag

Berlin/Heidelberg: Springer Berlin Heidelberg

Erscheinungsjahr

2019

Link zum Volltext

Quelle

SpringerLink (Online service)

Beschreibungen/Notizen

• Steroid-resistant acute graft-versus-host disease (GVHD) of the gastrointestinal tract associates with important morbidity and mortality. While high-dose steroids are the established first-line therapy in GVHD, no second-line therapy is generally accepted. In this analysis of 65 consecutive patients with severe, steroid-resistant, intestinal GVHD (92% stage 4), additional ileostomy surgery significantly reduced overall mortality (hazard ratio 0.54; 95% confidence interval, 0.36–0.81; p  = 0.003) compared to conventional GVHD therapy. Median overall survival was 16 months in the ileostomy cohort compared to 4 months in the conventional therapy cohort. In the ileostomy cohort, both infectious- and GVHD-associated mortality were reduced (40% versus 77%). Significantly declined fecal volumes ( p  = 0.001) after surgery provide evidence of intestinal adaptation following ileostomy. Correlative studies indicated ileostomy-induced immune-modulation with a > 50% decrease of activated T cells ( p  = 0.04) and an increase in regulatory T cells. The observed alterations of the patients’ gut microbiota may also contribute to ileostomy’s therapeutic effect. These data show that ileostomy induced significant clinical responses in patients with steroid-resistant GVHD along with a reduction of pro-inflammatory immune cells and changes of the intestinal microbiota. Ileostomy is a treatment option for steroid-resistant acute GVHD of the gastrointestinal tract that needs further validation in a prospective clinical trial.