Continuous octreotide infusion for the treatment of secretory diarrhea caused by acute intestinal graft-versus-host disease in a child

This report describes the use of octreotide, a synthetic somatostatin analo gue, for severe diarrhea caused by acute intestinal graft-versus-host disea se (GVHD) after bone marrow transplantation. A 22-month-old boy suffered gr ade 4 intestinal GVHD, with profuse diarrhea, intestinal inflammation, and grossly bloody stools after matched, unrelated donor transplant for bipheno typic leukemia. He required intensive blood product support. In addition to aggressive anti-GVHD therapy, octreotide acetate was initiated at 30 mu g (2 mu g/kg) intravenously 3 times per day and escalated to continuous infus ion at 15 mu g/hr (1 mu g/kg per hour). The diarrhea did not improve with a nti-GVHD treatment. However, moderate dose octreotide therapy resulted in p rompt control of the bloody diarrhea, which rebounded on cessation of octre otide therapy. Rebound diarrhea responded promptly when the dose of octreot ide was escalated. Octreotide was associated with an exacerbation of preexi sting hypertension, but it appeared to be effective for control of severe, bloody diarrhea caused by acute GVHD in a child, with manageable side effec ts. Further studies of this application in infants and children are warrant ed.