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Graft-Versus-Host Disease

A three or more drug combination as effective therapy for moderate or severe chronic graft-versus-host disease

Bone Marrow Transplantation volume 27, pages 45–51 (2001)Cite this article

Abstract

We analyzed the results of a three or more drug combination as treatment for moderate or severe cGVHD developing after transplantation for thalassemia, in 45 patients with median age of 11 (range 2–26) years. Eighteen patients received a three drug regimen with cyclosporine (CsA), methylprednisolone (MP) and azathioprine (AZ) as first line therapy, 16 patients received this regimen as salvage therapy and 11 patients were given a four or five drug regimen with CsA, MP, AZ, cyclophosphamide (CY) and/or methotrexate (MTX) mainly as salvage therapy. The overall complete response (CR) rate was 77.3%, with 94% of CR in patients receiving the three drug regimen as first line, 88% in patients receiving it as salvage therapy and 36.6% in patients given the four or five drug regimen. The probability of CR in patients given the three drug regimen as first or salvage therapy or the four/five drug regimen was 89%, 53% and 30%, while the probability of survival was 89%, 65% and 58%, respectively. The incidence of treatment failure was low in our patients. Patients treated with the three drug regimen as first line therapy had less treatment-related complications than patients receiving this regimen as salvage therapy or patients given the four or five drug regimen. The main causes of treatment-related mortality (20%) were infectious complications. This retrospective study showed that a three or more drug combination is safe and effective for treatment of moderate or severe cGVHD at least in younger patients. Bone Marrow Transplantation (2001) 27, 45–51.

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Acknowledgements

We thank Ms Law Aileen, member of our nursing staff, for linguistic assistance and all the members of our BMT Team for their exemplary care of these patients. This work has been supported by the Berloni Foundation against Thalassemia, Pesaro.

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  1. Divisione di Ematologia e Centro Trapianti di Midollo Osseo di Muraglia, Azienda Ospedaliera S Salvatore di Pesaro, Pesaro, Italy

    D Gaziev, G Lucarelli, P Polchi, E Angelucci, M Galimberti, C Giardini, D Baronciani, B Erer & P Sodani

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  1. D Gaziev
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  2. G Lucarelli
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  3. P Polchi
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  4. E Angelucci
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  5. M Galimberti
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  7. D Baronciani
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  8. B Erer
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  9. P Sodani
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Gaziev, D., Lucarelli, G., Polchi, P. et al. A three or more drug combination as effective therapy for moderate or severe chronic graft-versus-host disease. Bone Marrow Transplant 27, 45–51 (2001). https://doi.org/10.1038/sj.bmt.1702741

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