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Graft-Versus-Host Disease

Prophylaxis of graft-versus-host disease with cyclosporine–prednisone is associated with increased risk of chronic graft-versus-host disease

Bone Marrow Transplantation volume 27, pages 1133–1140 (2001)Cite this article

Abstract

To determine the effect of two different graft-versus-host disease (GVHD) prophylactic regimens – cyclosporine with short course of methotrexate (CYA-MTX) and cyclosporine with prednisone (CYA-PRED) – on the incidence of chronic GVHD (cGVHD), we retrospectively reviewed the outcomes of 196 consecutive allogeneic related blood and marrow transplants performed at our institution utilizing one of these regimens. CYA-PRED was given to patients who were transplanted more recently because of concern about the increased risk of veno-occlusive disease of the liver, increased mucositis, and slower engraftment in patients receiving CYA-MTX. Prophylaxis with CYA-PRED was associated with a higher risk of development of cGVHD (risk ratio (RR) 3.5; 95% confidence intrerval (CI), 2.2–5.4). The proportion of patients with extensive disease among those developing cGVHD was higher in the CYA-PRED group (71%) than in the CYA-MTX group (57%), although this difference was not statistically significant. The cumulative probability of extensive cGVHD at 2 years was higher in the CYA-PRED group (RR 4.2, 95% CI, 2.4–7.4). Development of acute GVHD and cytomegalovirus mismatch were independent predictors of increased risk of cGVHD. We conclude that GVHD prophylaxis with CYA-PRED is associated with a higher overall rate of cGVHD compared to CYA-MTX. The type of GVHD prophylaxis should be considered when comparing the incidence of cGVHD reported in different studies. Bone Marrow Transplantation (2001) 27, 1133–1140.

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Acknowledgements

We are indebted to Ms Norine E Huneke for her expert assistance with the BMT data management.

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Authors and Affiliations

  1. Division of Hematology and Internal Medicine, Mayo Clinic and Mayo Foundation, Rochester, Minnesota, USA

    S Kumar, DA Gastineau, MA Gertz, DJ Inwards, MQ Lacy, A Tefferi & MR Litzow

  2. Division of Radiation Oncology, Mayo Clinic and Mayo Foundation, Rochester, Minnesota, USA

    MG Chen

  3. Section of Biostatistics, Mayo Clinic and Mayo Foundation, Rochester, Minnesota, USA

    WS Harmsen

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Kumar, S., Chen, M., Gastineau, D. et al. Prophylaxis of graft-versus-host disease with cyclosporine–prednisone is associated with increased risk of chronic graft-versus-host disease. Bone Marrow Transplant 27, 1133–1140 (2001). https://doi.org/10.1038/sj.bmt.1703053

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