Systemic corticosteroid-free beclomethasone dipropionate monotherapy for mild acute gastrointestinal graft-versus-host disease after allogeneic hematopoietic cell transplantation

Systemic corticosteroids are the standard initial therapy for gastrointestinal graft-versus-host disease (GI-GVHD), but are associated with increased infectious risk and potential attenuation of graft-versus-leukemia effects. Beclomethasone dipropionate (BDP) has minimal gastrointestinal absorption and may provide localized efficacy, but evidence for monotherapy is limited. We retrospectively analyzed 37 patients who underwent first allogeneic hematopoietic cell transplantation and received oral BDP as initial monotherapy for acute GI-GVHD. Treatment response was assessed at days 28 and 56, and treatment failure was defined as initiation of systemic corticosteroids. All patients had stage 0-1 disease. Upper and lower GI-GVHD were observed in 24 (64.9%) and 13 (35.1%) patients, respectively. Response rates at days 28 and 56 were 62.9% and 65.6%. Treatment failure occurred more frequently in patients with lower GI-GVHD, female-to-male transplantation, and reduced-intensity conditioning. BDP monotherapy may be effective for selected patients with mild GI-GVHD, although careful monitoring is required in high-risk populations.