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| July (1) 2001, Volume 28, Number 1, Pages 39-45 |
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| Graft-Versus-Host Disease |
| Do corticosteroids add any benefit to standard GVHD prophylaxis in allogeneic BMT? |
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| I Ancín1, C Ferrá1, D Gallardo1, J Peris1, J Berlanga1, JR Gonzalez2, N Virgili3 and A Grañena1 |
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1Department of Clinical Hematology, Hospital Duran i Reynals, Institut Català d'Oncologia, Spain
2Cancer Prevention and Control Unit, Hospital Duran i Reynals, Spain
3Department of Endocrinology, Hospital Príncipes de España, Barcelona, Spain
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Correspondence to: Dr I Ancín, Department of Clinical Hematology, Hospital Duran i Reynals, Autovía de Castelldefells Km 2.7, 08907 L'Hospitalet de Llobregat, Barcelona, Spain; E-mail: 30.097iaa@comb.es
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| Abstract |
| In a retrospective study, we compared 15 patients who received cyclosporine (CsA), methotrexate (MTX) and prednisone (PDN) and 15 patients who received CsA-MTX for GVHD prophylaxis after allogeneic BMT (HLA-identical sibling (n = 22), related one HLA mismatch (n = 1), unrelated matched donors (n = 6), unrelated one HLA mismatch (n = 1)). The primary objectives of this study were to compare the incidence of GVHD and post-transplantation complications. Secondary objectives were to compare relapse rate, transplant-related mortality and overall survival. The incidence of acute GVHD grade III-IV was similar between the two groups (P = 0.66), as was the incidence of chronic GVHD (P = 0.67). Incidence of arterial hypertension was significantly higher in patients who received prophylactic PDN, (P = 0.03) and more insulin treatment was required in this group (P = 0.003). We observed no differences in the incidence of infections or upper digestive tract bleeding. Musculoskeletal complications appeared earlier in the group which received PDN. With a median follow-up of 4.4 years, patients in the CsA-MTX group had better overall survival, 46.7% vs 13.3% (P = 0.026). Relapse was a more frequent cause of death in the CsA-MTX group, whereas procedure-related mortality was more frequent in the CsA-MTX-PDN group (P = 0.013). These results suggest that prophylactic prednisone when combined with cyclosporine and methotrexate adds no benefit in acute or chronic GVHD prevention and may increase the morbidity of allogeneic transplantation. Corticosteroids may be reserved for GVHD treatment. Bone Marrow Transplantation (2001) 28, 39-45. |
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| Keywords |
| allogeneic bone marrow transplantation; acute graft-versus-host disease prophylaxis; corticosteroids |
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| Received 7 July 2000; accepted 7 March 2001 |
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| July (1) 2001, Volume 28, Number 1, Pages 39-45 |
| Table of contents Previous Abstract Next Full text PDF |
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