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Marrow Transplantation for Severe Aplastic Anemia: Methotrexate Alone Compared With a Combination of Methotrexate and Cyclosporine for Prevention of Acute Graft-Versus-Host Disease

Marrow Transplantation for Severe Aplastic Anemia: Methotrexate Alone Compared With a Combination of Methotrexate and Cyclosporine for Prevention of Acute Graft-Versus-Host Disease

Authors :
Storb, R.
Deeg, H.J.
Farewell, V.
Doney, K.
Appelbaum, F.
Beatty, P.
Bensinger, W.
Buckner, C.D.
Clift, R.
Hansen, J.
Hill, R.
Longton, G.
Lum, L.
Martin, P.
McGuffin, R.
Sanders, J.
Singer, J.
Stewart, P.
Sullivan, K.
Witherspoon, R.
Thomas, E.D.
Source :
Blood; July 1986, Vol. 68 Issue: 1 p119-125, 7p
Publication Year :
1986

Abstract

Forty-six patients with severe aplastic anemia (median age, 23 years) were treated with high-dose cyclophosphamide followed by infusion of marrow from an HLA-identical family member. To evaluate postgrafting prophylaxis for graft-v-host disease (GVHD), they were entered into a prospective randomized trial comparing the effect of a combination of methotrexate and cyclosporine (n = 22) to that of methotrexate alone (n = 24). Forty-four of the forty-six patients had evidence of sustained marrow engraftment. Only one patient in each of the two study groups showed graft rejection. A significant reduction in the cumulative incidence of grades II to IV acute GVHD was seen in patients given methotrexate/cyclosporine (18%) compared with those given methotrexate alone (53%) (P =. 012). In three patients given methotrexate alone. grade III developed, and in six, grade IV acute GVHD developed, compared with none given methotrexate/ cyclosporine. Eighteen of the 22 patients given methotrex-ate/cyclosporine and 15 of the 24 given methotrexate alone are alive between 5.5 and 44.5 months (median, 18 months), with actuarial survival rates at 2 years of 82% and 60%, respectively (P = .062). The incidence of fatal infections was higher in patients given methotrexate alone, whereas there are as yet no significant differences in the incidence of chronic GVHD. We conclude that methotrexate/cyclosporine treatment resulted in a significant decrease in the incidence and severity of acute GVHD in patients who received transplants for severe aplastic anemia and thus an improvement in survival. © 1986 by Grune & Stratton, Inc.

Details

Language :
English
ISSN :
00064971 and 15280020
Volume :
68
Issue :
1
Database :
Supplemental Index
Journal :
Blood
Publication Type :
Periodical
Accession number :
ejs57024809
Full Text :
https://doi.org/10.1182/blood.V68.1.119.119