scholarly journals Initial therapy of acute graft-versus-host disease with low-dose prednisone does not compromise patient outcomes

Blood ◽  
2009 ◽  
Vol 113 (13) ◽  
pp. 2888-2894 ◽  
Author(s):  
Marco Mielcarek ◽  
Barry E. Storer ◽  
Michael Boeckh ◽  
Paul A. Carpenter ◽  
George B. McDonald ◽  
...  
Keyword(s):  
Graft Versus Host Disease ◽  
Initial Treatment ◽  
Low Dose ◽  
Standard Dose ◽  
Equivalent Dose ◽  
Host Disease ◽  
Graft Versus Host ◽  
Number Of Patients ◽  
Dose Prednisone ◽  
Acute Graft

Abstract We hypothesized that initial treatment of acute graft-versus-host disease (GVHD) with low-dose glucocorticoids (prednisone-equivalent dose of 1 mg/kg per day) instead of standard-dose glucocorticoids (prednisone-equivalent dose of 2 mg/kg per day) does not compromise major transplantation outcomes. We retrospectively analyzed outcomes among 733 patients who received transplants between 2000 and 2005 according to initial treatment with low-dose (n = 347) versus standard-dose (n = 386) systemic glucocorticoids. The mean cumulative prednisone-equivalent doses at day 100 after starting treatment were 44 and 87 mg/kg for patients given low-dose and standard-dose glucocorticoids, respectively. Adjusted outcomes between the groups given low-dose versus standard-dose glucocorticoids were not statistically significantly different: overall mortality (hazard ratio [HR], 1.10; 95% confidence interval [CI], 0.9-1.4), relapse (HR, 1.22; 95% CI, 0.9-1.7), nonrelapse mortality (HR, 1.06; 95% CI, 0.8-1.5). The small number of patients with grades III/IV acute GVHD at onset precluded definitive conclusions for this subgroup. In multivariate analysis, the risks of invasive fungal infections (HR, 0.59; 95% CI, 0.3-1.0) and the duration of hospitalization (odds ratio, 0.62; 95% CI, 0.4-0.9) were reduced in the low-dose prednisone group. We conclude that initial treatment with low-dose glucocorticoids for patients with grades I-II GVHD did not compromise disease control or mortality and was associated with decreased toxicity.

Initial treatment of acute graft-versus-host disease with a murine monoclonal antibody directed to the human α/β T cell receptor

1991 ◽  
Vol 34 (2) ◽  
pp. 97-102 ◽  
Author(s):  
Dietrich W. Beelen ◽  
Hans Grosse-Wilde ◽  
Ursula Ryschka ◽  
Klaus Quabeck ◽  
Herbert G. Sayer ◽  
...  
Keyword(s):  
Monoclonal Antibody ◽  
T Cell ◽  
T Cell Receptor ◽  
Graft Versus Host Disease ◽  
Initial Treatment ◽  
Cell Receptor ◽  
Murine Monoclonal Antibody ◽  
Host Disease ◽  
Graft Versus Host ◽  
Acute Graft

Low-Dose Antithymocyte Globulin for Treatment of Steroid-Pulse-Resistant Acute Graft-versus-Host Disease

2003 ◽  
Vol 77 (1) ◽  
pp. 99-102 ◽  
Author(s):  
Kazuteru Ohashi ◽  
Yuji Tanaka ◽  
Shin-ichiro Mori ◽  
Yoshiki Okuyama ◽  
Kiyoshi Hiruma ◽  
...  
Keyword(s):  
Graft Versus Host Disease ◽  
Antithymocyte Globulin ◽  
Low Dose ◽  
Host Disease ◽  
Steroid Pulse ◽  
Graft Versus Host ◽  
Acute Graft

scholarly journals What role for prednisone in prevention of acute graft-versus-host disease in patients undergoing marrow transplants?

Blood ◽  
1990 ◽  
Vol 76 (5) ◽  
pp. 1037-1045 ◽  
Author(s):  
R Storb ◽  
M Pepe ◽  
C Anasetti ◽  
FR Appelbaum ◽  
P Beatty ◽  
...  
Keyword(s):  
Graft Versus Host Disease ◽  
Chronic Gvhd ◽  
Randomized Study ◽  
Disease Free Survival ◽  
Host Disease ◽  
Graft Versus Host ◽  
Number Of Patients ◽  
Leukemic Relapse ◽  
Cycle Dependent ◽  
Acute Graft

One hundred forty-seven consecutive patients with leukemia, myelodysplastic syndrome, or aplastic anemia were treated by marrow grafts from genotypically HLA-identical siblings (n = 122) or HLA- haploidentical family members (n = 25). Haploidentical recipients differed from their donors for no more than one HLA locus on the nonshared haplotype. All were given postgrafting immunosuppression with a combination of methotrexate and cyclosporine. In a randomized study we explored whether prednisone administered from day 0 through 35 along with methotrexate/cyclosporine could improve prevention of acute graft- versus-host disease (GVHD). The GVHD incidence in patients not given prednisone was comparable with that previously reported with methotrexate/cyclosporine. Unexpectedly, significant increases in acute and also chronic GVHD were seen in HLA-identical recipients administered prednisone, but not in the small number of patients administered HLA-nonidentical grafts. However, the resultant increase in transplant-related mortality in patients administered prednisone was offset by an increase in leukemic relapse in patients not administered prednisone, presumably related to the absence of a graft-versus- leukemia effect. Therefore, overall disease-free survival of the two groups of patients was comparable, with slightly more than 50% of the patients being alive at more than 2 years after transplantation. We speculated that prednisone adversely affected GVHD prophylaxis, interfering with methotrexate's cell cycle-dependent suppression of donor lymphocyte proliferation in response to host antigens. In a pilot study we explored whether beginning prednisone on day 15, after completion of methotrexate administration, would avoid this adverse effect. The GVHD incidence in patients administered methotrexate/cyclosporine along with “late” prednisone was comparable with that in patients not administered prednisone. We conclude that methotrexate/cyclosporine is effective in decreasing the incidence of grade II through IV GVHD, and that the addition of prednisone to this regimen is not beneficial in recipients of HLA-identical marrow grafts.

scholarly journals A retrospective analysis of therapy for acute graft-versus-host disease: initial treatment

Blood ◽  
1990 ◽  
Vol 76 (8) ◽  
pp. 1464-1472 ◽  
Author(s):  
PJ Martin ◽  
G Schoch ◽  
L Fisher ◽  
V Byers ◽  
C Anasetti ◽  
...  
Keyword(s):  
Treatment Failure ◽  
Graft Versus Host Disease ◽  
Initial Treatment ◽  
Initial Therapy ◽  
Time To Treatment ◽  
Host Disease ◽  
Graft Versus Host ◽  
Factors Associated ◽  
Time To Treatment Failure ◽  
Acute Graft

We have reviewed results of therapy in 740 patients with grades II-IV acute graft-versus-host disease (GVHD) after allogeneic marrow transplantation. At the beginning of therapy, 597 patients (81%) had rash, 369 (50%) had liver dysfunction and 396 (54%) had gut dysfunction. Initial treatment was with glucocorticoids (n = 531), cyclosporine (n = 170), antithymocyte globulin (ATG) (n = 156) or monoclonal antibody (n = 3) either singly (n = 633) or in combination (n = 107). Parameters of GVHD severity in each organ were recorded weekly, and evaluation of response was made using values at the initiation of secondary treatment or, for patients without such treatment, using values on day 29 of primary treatment or the last recorded value before death, whichever occurred first. Minimal criteria for improvement or progression were defined for each organ, but no attempt was made to define liver or gut outcome if another complication such as venocclusive disease or infectious enteritis was present. Improvement rates were 43% for skin disease, 35% for evaluable liver disease and 50% for evaluable gut disease. Overall complete or partial responses were seen in 44% of patients. Multivariate analyses were carried out to identify patient, disease or treatment factors associated with likelihood of overall improvement and likelihood of response in at least one organ. A similar analysis was also carried out to identify covariates associated with time to treatment failure (defined as initiation of secondary therapy or death not due to relapse of malignancy). In all three models, GVHD prophylaxis using cyclosporine combined with methotrexate was associated with favorable GVHD treatment outcome compared to prophylaxis with either agent alone, and treatment with glucocorticoids or cyclosporine was more successful than treatment with ATG. Other factors associated with unfavorable outcome in the model of time to treatment failure and also entered in one of the response models were recipient HLA disparity with the donor, presence of a liver complication other than GVHD, and early onset of GVHD. Results of this analysis indicate that glucocorticoids represent the best initial therapy available for treatment of acute GVHD, although much room for improvement remains.

Sign in / Sign up

Export Citation Format

Share Document