多発性骨髄腫における同種造血幹細胞移植後の慢性消化管 GVHD に対しベクロメタゾン腸溶性製剤を投与した症例

Graft-versus-host disease (GVHD) is still one of the most severe complications after allogeneic stem cell transplantation and systemic steroids continue to be the standard first-line treatment.However,immunosuppressive therapy using systemic steroids produces adverse effects and their use for this purpose increases the risk of opportunistic infections,glucose intolerance,and bone demineralization.However,many of the adverse effects associated with systemic steroids can be avoided through the use of beclomethasone dipropionate (BDP),a topically active corticosteroid used in inhalation-type medicines,since it is highly metabolized in mucous membranes.In addition,BDP has a stronger anti-inflammatory action than dexamethasone and it has been reported that BDP is effective for Crohn’s disease and inflammatory bowel diseases.In this study,the authors administered BDP to a chronic GVHD patient with poor condition control.The drug was contained in gastro-resistant capsules and administered 4 times a day at a dose of 4 mg.This resulted in a temporary improvement in the inflammation in the enteric canal over a period of 75 days.There was also an improvement in the mucous membrane edema that had been observed in the intestines.In addition,none of the adverse effects usually caused by the administration of systemic steroids was observed.