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

S. Kumar, M. G. Chen, D. A. Gastineau, M. A. Gertz, D. J. Inwards, M. Q. Lacy, A. Tefferi, W. S. Harmsen, M. R. Litzow

Research output: Contribution to journalArticle

6 Scopus citations

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 interval (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.

Original languageEnglish (US)
Pages (from-to)1133-1140
Number of pages8
JournalBone Marrow Transplantation
Volume27
Issue number11
DOIs
StatePublished - Jul 12 2001

Keywords

  • Allogeneic bone marrow transplantation
  • CYA
  • Cytomegalovirus
  • MTX
  • Prednisone
  • Survival

ASJC Scopus subject areas

  • Hematology
  • Transplantation

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