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Graft-Versus-Host Disease

Cyclosporine alone vs cyclosporine plus methotrexate for post-transplant immunosuppression after HLA-identical sibling bone marrow transplantation: a randomized prospective study

Bone Marrow Transplantation volume 34, pages 627–636 (2004)Cite this article

Summary:

The role of methotrexate (MTX), given with cyclosporine (CS), after HLA-identical sibling bone marrow transplantation needs to be defined. In all, 80 patients with hematologic malignancies were enrolled in a prospective randomized trial. All were given BuCy conditioning. The 40 patients in the CS arm received CS 3 mg/kg/day intravenously, with subsequent oral dosing. Patients in the CS+MTX arm received, in addition to CS, MTX intravenously, 15 mg/m2 on day 1, and 10 mg/m2 on days 3, 6, and 11. Transplantation-related mortality was low in both groups of patients (13 vs 11% for CS vs CS+MTX groups, P=0.94). The CS group had a significantly higher frequency of chronic graft-versus-host disease (56 vs 32%, P=0.05). After a median follow-up of 22.1 months (5.1–47.8 months), three of 30 vs 10 of 28 patients with acute leukemia/myelodysplastic syndrome (MDS) in CS group vs CS+MTX group relapsed (P=0.01) yielding better overall survival for patients with acute leukemia/MDS treated with CS (P=0.02). After HLA-identical sibling bone marrow transplantation, immunosuppression with CS, with or without MTX, resulted in similarly low transplantation-related mortality. In acute leukemia/MDS, decreased relapse with patient survival prolongation was observed in the CS group.

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  1. Department of Internal Medicine, Sections of Hematology and Oncology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea

    K-H Lee, S-J Choi, J-H Lee, S Kim, M Seol, Y-S Lee, W-K Kim, J-S Lee & J-H Lee

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Lee, KH., Choi, SJ., Lee, JH. et al. Cyclosporine alone vs cyclosporine plus methotrexate for post-transplant immunosuppression after HLA-identical sibling bone marrow transplantation: a randomized prospective study. Bone Marrow Transplant 34, 627–636 (2004). https://doi.org/10.1038/sj.bmt.1704624

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