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Oral beclomethasone dipropionate as an initial treatment of gastrointestinal acute graft-versus-host disease after reduced-intensity cord blood transplantation

Bone Marrow Transplantation volume 38, pages 577–579 (2006)Cite this article

Beclomethasone dipropionate (BDP) is a potent topically active corticosteroid. BDP is hydrolyzed to an active metabolite, beclomethasone 17-monopropionate, by esterase enzymes in the intestinal and bronchial mucosa. Systemic adverse effects are limited by incomplete mucosal absorption and rapid metabolism in the liver.1 BDP had been developed as inhalant corticosteroid for the treatment of asthma and allergic rhinitis, then the efficacy of topical BDP was shown in the treatment of Crohn's or inflammatory bowel disease.2, 3 Oral BDP (6–10 mg/body/day) or BDP enema (3–5 mg/body/day) was used in these studies.

The pathological and clinical findings of gastrointestinal (GI) graft-versus-host disease (GVHD) are similar to those of inflammatory bowel disease. Three previous studies had shown the safety and efficacy of the topical BDP for GI GVHD. A phase I trial from the Fred Hutchinson Cancer Research Center (FHCRC) showed that 23 patients with mild to moderate GI acute GVHD were given oral BDP at a daily dose of 8 mg/body as an initial therapy. The response rate was 77%, and no patient presented with severe infection or adrenal insufficiency.4 A randomized placebo-controlled trial from FHCRC demonstrated that response rates were significantly higher in patients given oral BDP and prednisone than those given prednisone alone as initial therapy for GI acute GVHD (71 versus 41%).5 A phase II trial by Iyer et al.6 showed that long-term use of oral BDP for the treatment of GI GVHD, which included chronic GVHD mainly, was safe and effective.

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Authors and Affiliations

  1. Department of Hematology, Toranomon Hospital, Tokyo, Japan

    Y Miura, H Narimatsu, E Kusumi, T Matsumura, K Yuji, A Wake, S Miyakoshi & S Taniguchi

  2. Division of Exploratory Research, Institute of Medical Science, University of Tokyo, Tokyo, Japan

    M Kami

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  1. Y Miura
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  2. H Narimatsu
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Correspondence to M Kami.

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Miura, Y., Narimatsu, H., Kami, M. et al. Oral beclomethasone dipropionate as an initial treatment of gastrointestinal acute graft-versus-host disease after reduced-intensity cord blood transplantation. Bone Marrow Transplant 38, 577–579 (2006). https://doi.org/10.1038/sj.bmt.1705489

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