Abstract
High-dose steroids are the first line of treatment for acute graft-versus-host disease (aGVHD). Steroid myopathy is a debilitating steroid-induced complication that significantly impairs a patient's performance status. To determine the frequency and severity of steroid myopathy and other steroid related complications in patients with acute myeloid leukemia (AML)/myelodysplastic syndrome (MDS) who developed grade ⩾2 aGVHD after allogeneic hematopoietic stem cell transplantation (HSCT), we performed a retrospective analysis. Patients were included in the analysis if they had a diagnosis of AML/MDS, underwent an allogeneic HSCT between January 1996 and December 2001 and developed grade ⩾2 aGVHD that was treated with 2 mg/kg of methylprednisolone and survived at least 100 days post transplant. A total of 70 patients fulfilled our inclusion criteria. Steroid myopathy was identified in 29 (41%) patients. Steroid myopathy was generally of moderate severity with severe debilitating steroid myopathy seen in only 3% of patients. We concluded that steroid myopathy is a common complication of high-dose steroid therapy after allogeneic HSCT in AML/MDS. Interventions aimed at preventing and treating this complication are warranted and need to be explored in prospective clinical trials.
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References
Thomas ED . Karnofsky Memorial Lecture. Marrow transplantation for malignant diseases. J Clin Oncol 1983; 1: 517–531.
Antin JH, Ferrara J . Cytokine dysregulation and acute graft-versus-host disease. Blood 1992; 80: 2964–2968.
Ferrara J, Deeg HJ . Graft versus host disease. N Engl J Med 1991; 324: 667–674.
Chao NJ, Schmidt GM, Niland JC, Amylon MD, Dagis AC, Long GD et al. Cyclosporine, methotrexate, and prednisone Compared with cyclosporine and prednisone for prophylaxis of acute graft-versus-host disease. N Engl J Med 1993; 329: 1225–1230.
Martin PJ, Schoch G, Fisher L, Byers V, Anasetti C, Appelbaum FR et al. A retrospective analysis of therapy for acute graft versus-host disease: initial treatment. Blood 1990; 76: 1464–1472.
Ruutu T, Hermans J, van Biezen A, Niederwieser D, Gratwohl A, Apperley JF . How should corticosteroids be used in the treatment of acute GVHD? EBMT Chronic Leukemia Working Party. European Group for Blood and Marrow Transplantation. Bone Marrow Transplant 1998; 22: 614–615.
Ruutu T, Niederwieser D, Gratwohl A, Apperley JF . A survey of the prophylaxis and treatment of acute GVHD in Europe: a report of the European Group for Blood and Marrow, Transplantation (EBMT). Chronic Leukaemia Working Party of the EBMT. Bone Marrow Transplant 1997; 19: 759–764.
Cushing H . The basophil adenomas of the pituitary body and their clinical manifestation. Johns Hopkins Med J 1932; 50: 137.
Batchelor TT, Taylor LP, Thaler HT, Posner JB, DeAngelis LM . Steroid myopathy in cancer patients. Neurology 1997; 48: 1234–1238.
Afifi AK, Bergman RA, Harvey JC . Steroid myopathy. Clinical, histologic and cytologic observations. Johns Hopkins Med J 1968; 123: 158–173.
Heinemann AW, Linacre JM, Wright BD, Hamilton BB, Granger C . Prediction of rehabilitation outcomes with disability measures. Arch Phys Med Rehabil 1994; 75: 133–143.
Kendall FP, McCreary EK, Provance PG . Muscles: Testing and Function, 4th edn. Williams & Wilkins: Baltimore, 1993.
Linacre JM, Heinemann AW, Wright BD, Granger CV, Hamilton BB . The structure and stability of the Functional Independence Measure. Arch Phys Med Rehabil 1994; 75: 127–132.
Schacke H, Docke WD, Asadullah K . Mechanisms involved in the side effects of glucocorticoids. Pharmacol Ther 2002; 96: 23–43.
Stuck AE, Minder CE, Frey FJ . Risk of infectious complications in patients taking glucocorticosteroids. Rev Infect Dis 1989; 11: 954–963.
Hings IM, Filipovich AH, Miller WJ, Blazar BL, McGlave PB, Ramsay NK . Prednisone therapy for acute graft-versus host disease: short- versus long-term treatment. A prospective randomized trial. Transplantation 1993; 56: 577–580.
Hamon MD, Gale RF, Macdonald ID, Smith OP, Collis CH, Skeggs DB . Incidence of cataracts after single fraction total body irradiation: the role of steroids and graft versus host disease. Bone Marrow Transplant 1993; 12: 233–236.
Hardie IR, Matsunami C, Hilton A . Ocular complications in renal transplant recipients. Transplant Proc 1992; 24: 177.
Pai RP, Mitchell P, Chow VC . Post-transplant cataract: lesson from kidney–pancreas transplantation. Transplantation 2000; 69: 1108.
Bray LC, Carey PJ, Proctor SJ, Evans RG, Hamilton PJ . Ocular complications of bone marrow transplantation. Br J Ophthalmol 1991; 75: 611–614.
Andrews RC, Walker BR . Glucocorticoids and insulin resistance: old hormones, new targets. Clin Sci (London) 1999; 96: 513–523.
Ullrich S, Berchtold S, Ranta F, Ris F, Rosler M, Gerlach U et al. Serum- and glucocorticoid-inducible kinase 1 (SGK1) mediates glucocorticoid-induced inhibition of insulin secretion. Diabetes 2005; 54: 1090–1099.
Raul Ariza-Andraca C, Barile-Fabris LA, Frati-Munari AC, Baltazar-Montufar P . Risk factors for steroid diabetes in rheumatic patients. Arch Med Res 1998; 29: 259–262.
Jindal RM, Hjelmesaeth J . Impact and management of posttransplant diabetes mellitus. Transplantation 2000; 70 (Suppl 11): 58.
Shapiro R, Scantlebury VP, Jordan ML . Reversibility of tacrolimus-induced posttransplant diabetes: an illustrative case and review of the literature. Transplant Proc 1997; 10: 760.
Lifton RP, Gharavi AG, Geller DS . Molecular mechanisms of human hypertension. Cell 2001; 104: 545.
Midtvedt KN, Neumayer HH . Management strategies for posttransplant hypertension. Transplantation 1998; 70 (11 Suppl): 64.
Covar RA, Leung DY, McCormick D, Steelman J, Zeitler P, Spahn JD . Risk factors associated with glucocorticoid-induced adverse effects in children with severe asthma. J Allergy Clin Immunol 2000; 59106: 651–656.
Renold AE, Haydar NA, Reddy WJ, Goldfien A, St Marc JR, Laidlaw JC . Biological effects of fluorinated derivatives of hydrocortisone and progesterone in man. Ann NY Acad Sci 1955; 61: 582–590.
Thorn GW, Renold AE, Morse WI, Goldfien A, Reddy WJ . Highly potent adrenal cortical steroids: structure and biologic activity. Ann Intern Med 1955; 43: 979–1000.
Price SR, Du JD, Bailey JL, Mitch WE . Molecular mechanisms regulating protein turnover in muscle. Am J Kidney Dis 2001; 37 (1 Suppl 2): S112–S114.
Khaleeli AA, Edwards RH, Gohil K, McPhail G, Rennie MJ, Round J et al. Corticosteroid myopathy: a clinical and pathological study. Clin Endocrinol (Oxford) 1983; 18: 155–166.
Bielefeld P . Actualites sur la myopathie cortisonique. La Revue Med Interne 1996; 17: 255.
Shee CD . Risk factors for hydrocortisone myopathy in acute severe asthma. Respir Med 1990; 84: 229–233.
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Lee, H., Oran, B., Saliba, R. et al. Steroid myopathy in patients with acute graft-versus-host disease treated with high-dose steroid therapy. Bone Marrow Transplant 38, 299–303 (2006). https://doi.org/10.1038/sj.bmt.1705435
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DOI: https://doi.org/10.1038/sj.bmt.1705435
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