This phase II trial studies how well methylprednisolone sodium succinate works in treating patients with graft-versus-host disease (GVHD) of the gastrointestinal tract that has begun within 100 days of transplant (acute GVHD). Corticosteroids are a type of drug that reduces inflammation. Giving corticosteroid drugs, such as methylprednisolone sodium succinate, directly into the arteries of the gastrointestinal tract may help treat inflammation caused by GVHD. Giving methylprednisolone sodium succinate in addition to standard treatments may be more effective in treating GVHD.
PRIMARY OBJECTIVES: I. To assess the efficacy of intra-arterial steroid administration (IASA) with methylprednisolone sodium succinate (MePDSL) in this dose-schedule for treatment of de novo acute moderate-to-severe GvHD of the gastrointestinal tract (GIT). SECONDARY OBJECTIVES: I. To assess the safety of IASA MePDSL in this dose-schedule for treatment of de novo acute moderate-to-severe acute GvHD of the GIT. II. To assess the feasibility of IASA MePDSL in this dose-schedule for treatment of de novo acute moderate-to-severe acute GvHD of the GIT. OUTLINE: STUDY AGENT: Patients receive methylprednisolone sodium succinate intra-arterially (IA) once daily (QD) on days 1-3. CONVENTIONAL THERAPY: Patients also receive conventional therapy comprising methylprednisolone sodium succinate intravenously (IV) every 12 hours on for 7-14 days beginning on day 1 and budesonide PO on days 1-56. Patients with response by day 7-14 may begin taper and receive methylprednisolone orally (PO) on days 28-56. Treatment continues in the absence of disease progression or unacceptable toxicity. IMMUNOSUPPRESSIVE THERAPY (IST): Patients receive conventional IST or continue their previous prophylactic regimen beginning on day 1 to 56 (or beyond) at the discretion of the treating physician. After completion of study treatment, patients are followed up for 360 days.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Given PO
Given IA and IV
Comprehensive Cancer Center of Wake Forest University
Winston-Salem, North Carolina, United States
Incidence of discontinuation of systemic GCs without acute GvHD flare and without disease progression/recurrence
Time frame: Day 56
Incidence of discontinuation of systemic GCs without acute GvHD flare and without disease progression/recurrence
Time frame: By day 180
Incidence of discontinuation of systemic GCs without acute GvHD flare and without disease progression/recurrence
Time frame: By day 360
Proportions of response among surviving patients
Time frame: Day 14
Proportions of progression among surviving patients
Time frame: Day 14
Rate of acute (and/or chronic) GvHD-free survival
Simon's two-stage design will be used. The null hypothesis that the true CR rate is 30% will be tested against a one-sided alternative and presented with a 95% confidence interval.
Time frame: Day 56
Proportions of response among surviving patients
Time frame: Day 28
Proportions of progression among surviving patients
Time frame: Day 28
Daily and cumulative GC dose
Descriptive measures will be provided at each time point specified.
Time frame: Day 28
Feasibility
Feasibility will be defined as less than three IASA sessions for any reason and obvious procedure-related problems in \>= 10% of patients. Descriptive measures will be provided at each time point specified.
This platform is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional.
Time frame: Up to day 360
GvHD-free survival
Descriptive measures will be provided at each time point specified. Survival estimates will be calculated using Kaplan-Meier estimation.
Time frame: Day 180
GvHD-free survival
Descriptive measures will be provided at each time point specified. Survival estimates will be calculated using Kaplan-Meier estimation.
Time frame: Day 360
Incidence of acute GvHD "flare" after CR/PR requiring modification and/or additional agents (and/or 2.5 mg/kg/day of prednisone [or methylprednisolone equivalent of 2 mg/kg/day]) for systemic therapy
Descriptive measures will be provided at each time point specified.
Time frame: Up to day 56
Incidence of chronic GvHD
Descriptive measures will be provided at each time point specified.
Time frame: By day 180
Incidence of chronic GvHD
Descriptive measures will be provided at each time point specified.
Time frame: By day 360
Incidence of National Cancer Institute Common Terminology Criteria for Adverse Events version 4.0 toxicities
Frequencies of toxicities grade 2 or higher will be totaled at the conclusion of the study.
Time frame: Up to day 360
Incidence of opportunistic infections
Descriptive measures will be provided at each time point specified.
Time frame: Day 180
Non-relapse mortality (NRM)
Descriptive measures will be provided at each time point specified.
Time frame: Day 180
NRM
Descriptive measures will be provided at each time point specified.
Time frame: Day 360
Overall survival
Descriptive measures will be provided at each time point specified. Survival estimates will be calculated using Kaplan-Meier estimation.
Time frame: Day 180
Overall survival
Descriptive measures will be provided at each time point specified. Survival estimates will be calculated using Kaplan-Meier estimation.
Time frame: Day 360