Abstract
Objective
To present a multiyear clinical experience with intravenous bevacizumab for the management
of severe gastrointestinal bleeding and/or epistaxis in patients with hereditary hemorrhagic
telangiectasia (HHT).
Patients and Methods
All patients treated with intravenous bevacizumab for severe hereditary hemorrhagic
telangiectasia–related bleeding from June 1, 2013, through January 31, 2017, were
included in this report. Severity of epistaxis (determined using the Epistaxis Severity
Score questionnaire); hemoglobin, iron, and ferritin levels; and quality of life data
were collected serially in all patients.
Results
Intravenous bevacizumab was administered to 34 patients using a standardized treatment
protocol. Anemia was primarily related to severe epistaxis (n=15, 44%), severe gastrointestinal
bleeding (n=4, 12%), or both (n=15, 44%), with a median baseline hemoglobin level
of 9.1 g/dL (range, 8.3-10.5 gm/dL; to convert to mmol/L, multiply by 0.62). Red blood
cell (RBC) transfusions had been administered to 28 patients (82%). Of these, 16 patients
(47%) were RBC transfusion dependent and had received a median of 75 RBC transfusions
(range, 4->500 RBC units) before bevacizumab initiation. The median length of follow-up
was 17.6 months from the beginning of bevacizumab treatment (range, 3-42.5 months).
There was a significant reduction in epistaxis severity scores (P<.001) and RBC transfusion requirements (P=.007) after completion of the initial bevacizumab treatment cycle. New-onset or worsened
hypertension was noted in 4 patients, with 1 patient experiencing hypertensive urgency
with a temporary decline in renal function.
Conclusion
Intravenous bevacizumab is an effective treatment option for patients with severe
anemia related to epistaxis and/or gastrointestinal bleeding. Further studies are
needed to establish a dose-response relationship as well as clinical, genetic, and
biomarker predictors of response.
Abbreviations and Acronyms:
AVM (arteriovenous malformation), E-QOL (epistaxis-related quality of life), ESS (Epistaxis Severity Score), GI (gastrointestinal), HHT (hereditary hemorrhagic telangiectasia), HTN (hypertension), IV (intravenous), QOL (quality of life), RBC (red blood cell), VEGF (vascular endothelial growth factor)To read this article in full you will need to make a payment
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Article Info
Publication History
Published online: January 24, 2018
Accepted:
November 20,
2017
Received in revised form:
November 2,
2017
Received:
September 7,
2017
Footnotes
For editorial comment, see page 130
Potential Competing Interests: The authors report no competing interests.
Identification
Copyright
© 2017 Mayo Foundation for Medical Education and Research
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- CorrectionMayo Clinic ProceedingsVol. 93Issue 3
- PreviewIn the Original Article entitled, “Intravenous Bevacizumab for Refractory Hereditary Hemorrhagic Telangiectasia–Related Epistaxis and Gastrointestinal Bleeding” published in the February 2018 issue of Mayo Clinic Proceedings (Mayo Clin Proc. 2018;93(2):155-166), an error is present in Table 4. In the Variable for All patients (N=34), Any transfusion, n (%), under Before bevacizumab treatment at 6 mo, the value should be 16 (47).
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