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Corticosteroids in the prevention of graft-vs-host disease after allogeneic myeloablative stem cell transplantation: a systematic review and meta-analysis

Leukemia volume 22, pages 1801–1803 (2008)Cite this article

The occurrence of graft-vs-host disease (GvHD) remains one of the major drawbacks limiting the wider application of allogeneic haematopoietic stem cell transplantation (HSCT) preceded by the use of a myeloablative conditioning regimen. GvHD is considered the main cause for transplant-related morbidity and mortality. The median occurrence of clinically significant acute GvHD (grade II–IV) is about 40%, ranging from 10 to 80% depending on the conditioning therapies used and patient-related risk factors. For acute GvHD Grade IV, the treatment-related mortality can exceed 90%. Chronic GvHD represents one of the most common late challenges of allogeneic HSCT— approximately 50% of the patients experience some degree of chronic GvHD ranging from 30 to 80%. Chronic GvHD is the leading cause of non-relapse related deaths.

Taking into account the impact of GvHD on patients’ survival and quality of life, the effective prophylaxis of GvHD is of vital importance. Removing T cells by in vitro treatment of the donor marrow is one of the most effective ways to reduce the occurrence and the severity of acute GvHD. Unfortunately, non-specific T-cell depletion increases the rates of graft failure, infections and relapses due to the absence of the beneficial graft-vs-leukaemia effect, resulting in an equivalent overall survival. Currently, the most common applied approach for GvHD prevention in transplantations preceded by myeloablative conditioning is the prophylactic use of a regimen with immunosuppressive agents given post transplant: it combines cyclosporine A (CSP) for 6 months (3 mg/kg/day on day −1 through day 10, then oral application tapered off until day +180) with a short-course of methotrexate (MTX) (15 mg/qm on day 1; 10 mg/qm on days 3, 6 and 11). Also combinations with ‘mini-methotrexate’ (5 mg/qm on days 1, 3, 6 and 11) or ‘very-short methotrexate’ (omitting the fourth dose on day 11) are used or under clinical investigation. However, it is uncertain whether the addition of corticosteroids provides an advantage by potentially decreasing the occurrence of GvHD as, on the other hand, corticosteroids may augment the risk for infections and consequently may increase mortality. According to the Handbook of the European Group for Bone and Marrow Transplantation (EBMT), the role of methylprednisolone to prevent GvHD is controversial: the results of single studies are ambiguous and no systematic review assessing the role of corticosteroids for preventing GvHD after allogeneic myeloablative HSCT has been published so far.

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Authors and Affiliations

  1. Cochrane Haematological Malignancies Group, Clinic I of Internal Medicine, University of Cologne, Cologne, Germany

    S Quellmann, A Engert & J Bohlius

  2. Institute of Medical Biometry and Medical Informatics, University Medical Center Freiburg, Freiburg, Germany

    G Schwarzer

  3. Clinic I of Internal Medicine, University of Cologne, Cologne, Germany

    K Hübel

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  1. S Quellmann
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  2. G Schwarzer
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Correspondence to S Quellmann.

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Quellmann, S., Schwarzer, G., Hübel, K. et al. Corticosteroids in the prevention of graft-vs-host disease after allogeneic myeloablative stem cell transplantation: a systematic review and meta-analysis. Leukemia 22, 1801–1803 (2008). https://doi.org/10.1038/leu.2008.105

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