Impact of Day +11 Methotrexate on the Incidence of Graft-versus-host Disease after HLA-identical Allogeneic Peripheral Blood Stem Cell Transplantation.
- Author:
Byung Min AHN
1
;
Yee Ryong JUNG
;
Kyu Bo LEE
;
Sang Kyun SOHN
;
Jong Gwang KIM
;
Jin Ho BAEK
;
Yoon Young CHO
;
Yee Soo CHAE
;
Seok Bong JEON
;
Joon Ho MOON
;
Shi Nae KIM
;
Soo Jung LEE
;
Jang Soo SUH
;
Kun Soo LEE
Author Information
- Publication Type:Original Article
- Keywords: Methotrexate; Graft-versus-host disease; Allogeneic peripheral blood stem cell transplantation
- MeSH: Cyclosporine; Graft vs Host Disease*; Humans; Incidence*; Methotrexate*; Mucositis; Multivariate Analysis; Peripheral Blood Stem Cell Transplantation*; Recurrence; Renal Insufficiency
- From:Korean Journal of Hematology 2006;41(2):73-82
- CountryRepublic of Korea
- Language:Korean
- Abstract: BACKGROUND: Cyclosporine (CSA) plus 4 doses of methotrexate (MTX) is the commonly used regimen for GVHD prophylaxis. It has been previously found that the omission of the day +11 dose of MTX was associated with an increased risk of acute GVHD in the allogeneic BMT setting. However, little is known about its impact in the PBSCT setting. METHODS: Of the 68 patients, 30 patients (44%) received 4 doses of MTX (the MTX4 group), while 38 patients (56%) received less than 4 doses (the MTX3 group) because of their severe mucositis, hepatic dysfunction or renal failure. RESULTS: The cumulative incidence of acute GVHD was 60% in the MTX4 and 86% in the MTX3 group (P=0.038), while that of grade III and IV acute GVHD was 7% in the MTX4 group and 39% in the MTX3 group (P=0.017). Of the 61 patients evaluated for chronic GVHD, the cumulative incidence of chronic GVHD was 54% in the MTX4 group and 97% in the MTX3 group (P=0.001), while that of extensive chronic GVHD was 26% in the MTX4 group and 63% in the MTX3 group (P=0.004). There were no differences in the overall survival and the incidence of relapse between the two groups. On multivariate analyses, MTX3 was a poor prognostic factor in terms of acute GVHD and extensive chronic GVHD. CONCLUSION: This study suggested that omitting day +11 MTX and the clinical situation of the MTX3 group seemed to be associated with an increased incidence of acute and chronic GVHD. Accordingly, administration of day +11 MTX accompanied by active treatment of mucositis may prevent GVHD in the allogeneic PBSCT setting, but we need to conduct a large scale prospective study.
