Cyclosporine combined with methylprednisolone or methotrexate in prophylaxis of moderate to severe acute graft-versus-host disease

Bone Marrow Transplant. 1993 Nov;12(5):437-41.

Abstract

To evaluate the efficacy of cyclosporine (CYA) regimens in preventing moderate to severe acute graft-versus-host disease (GVHD), 25 patients received immunosuppressive therapy consisting of either CYA and methylprednisolone or CYA and methotrexate (MTX) and the incidence and severity of acute GVHD was compared. These patients had leukemia or myelodysplastic syndrome (MDS) and received bone marrow transplants (BMT) from genotypically HLA-identical siblings. The incidence of grade I-IV acute GVHD in patients on the CYA/methylprednisolone regimen was 64% (7 of 11) compared with 50% (7 of 14) in those on the CYA/MTX regimen. Five of 11 patients with the CYA/methylprednisolone regimen developed moderate to severe acute GVHD (grade II-IV), fatal in 3 cases. No patient on the CYA/MTX regimen developed moderate to severe acute GVHD. Engraftment was faster in the CYA/methylprednisolone group than in the CYA/MTX group. The incidence of toxicity observed soon after BMT was comparable between groups. The CYA/MTX regimen may be superior to the CYA/methylprednisolone regimen for preventing moderate to severe acute GVHD.

Publication types

  • Clinical Trial
  • Comparative Study
  • Controlled Clinical Trial

MeSH terms

  • Acute Disease
  • Adolescent
  • Adult
  • Bone Marrow Transplantation / adverse effects
  • Cyclosporine / adverse effects
  • Cyclosporine / standards*
  • Cyclosporine / therapeutic use
  • Drug Therapy, Combination
  • Female
  • Graft vs Host Disease / epidemiology
  • Graft vs Host Disease / etiology
  • Graft vs Host Disease / prevention & control*
  • Humans
  • Incidence
  • Japan / epidemiology
  • Leukemia, Myeloid / drug therapy
  • Leukemia, Myeloid / epidemiology
  • Leukemia, Myeloid / therapy
  • Male
  • Methotrexate / adverse effects
  • Methotrexate / standards*
  • Methotrexate / therapeutic use
  • Methylprednisolone / adverse effects
  • Methylprednisolone / standards*
  • Methylprednisolone / therapeutic use
  • Middle Aged
  • Myelodysplastic Syndromes / drug therapy
  • Myelodysplastic Syndromes / epidemiology
  • Myelodysplastic Syndromes / therapy
  • Precursor Cell Lymphoblastic Leukemia-Lymphoma / drug therapy
  • Precursor Cell Lymphoblastic Leukemia-Lymphoma / epidemiology
  • Precursor Cell Lymphoblastic Leukemia-Lymphoma / therapy
  • Severity of Illness Index

Substances

  • Cyclosporine
  • Methylprednisolone
  • Methotrexate