Treatment of intestinal graft-versus-host disease using betamethasone enemas

Intestinal graft-versus-host disease (GVHD) can readily easily induce gener alized metabolic disturbance that influences morbidity and mortality after allogeneic bone marrow transplantation. Although adding a new drug or incre asing the doses of immunosuppressive agents will probably be effective for controlling intestinal GVHD, the systemic side effects of such therapy cann ot be ignored. In this study, we used betamethasone retention enemas as a l ocal treatment for eight patients with refractory and/or severe intestinal GVHD. Six of the eight patients showed improvement of diarrhea and/or abdom inal pain, with a reduction in the stage of GVHD. When treatment with betam ethasone enemas was continued for 10 to 27 days in the 6 responding patient s, no severe toxicity was observed. One patient failed to respond to treatm ent and another could not tolerate the enemas. Despite some uncertainty reg arding the indications and duration of treatment, betamethasone enemas seem to be a potential alternative method for the management of intestinal GVHD . Despite recent progress in the management of graft-versus-host disease (G VHD) after allogeneic bone marrow transplantation (BMT), it is still one of the most important complications. Intestinal GVHD presents with watery or bloody diarrhea and/or abdominal pain, which is occasionally complicated by ileus (1). Appropriate treatment is needed, because intestinal GVHD can re adily cause complications that influence the outcome of BMT. The recommende d treatment for intestinal GVHD is generally systemic administration of imm unosuppressive agents such as glucocorticoids or antithymocyte globulin (2) . Although these treatments are generally effective, symptoms may persist d espite powerful and long-term immunosuppression in some patients. In such c ases, various side effects of the drugs may occur, including fatal opportun istic infections, especially those caused by cytomegalovirus. In our study, we treated eight patients who had severe and refractory intestinal GVHD wi th betamethasone enemas as a local therapy.