title: Decreased incidence of graft-versus-host disease and improved survival with methotrexate combined with cyclosporin compared with monotherapy in recipients of bone marrow from donors other than HLA identical siblings.
abstract: Recipients receiving marrow from donors other than HLA identical siblings (alternative donors) treated by monotherapy with either methotrexate (MTX, n = 5) or cyclosporin A (CSA, n = 10) were compared with 28 recipients of alternative donor marrow receiving MTX + CSA. The former group had a cumulative incidence of grade II-IV acute graft-versus-host disease (GVHD) of 73% compared with 34% in the latter group (p = 0.009). The incidence of chronic GVHD was 75% and 41% in the two groups respectively, a difference that was not statistically significant. Death caused by GVHD was 47% in recipients of alternative bone marrow treated with monotherapy vs 12% in those treated with MTX + CSA (p = 0.008). The actuarial 4-year patient survival was 7% and 46% in the two groups, respectively (p = 0.04). Compared with HLA identical siblings the recipients of alternative marrow treated with monotherapy had an increased risk of grade II-IV acute GVHD (p less than 0.0001), an increased death rate by GVHD (p = 0.0001) and a decreased survival (p less than 0.0001). When MTX was combined with CSA the recipients of alternative marrow had an increased risk of grade II-IV acute GVHD (p = 0.005), but death by GVHD (12 vs 6%) and 4-year patient survival (46 vs 45%) did not differ.
authors.affiliation: Department of Clinical Immunology, Karolinska Institute, Huddinge Hospital, Stockholm, Sweden.
authors.forename: O
authors.initials: O
authors.lastname: Ringdén
authors.forename: S
authors.initials: S
authors.lastname: Klaesson
authors.forename: B
authors.initials: B
authors.lastname: Sundberg
authors.forename: P
authors.initials: P
authors.lastname: Ljungman
authors.forename: B
authors.initials: B
authors.lastname: Lönnqvist
authors.forename: U
authors.initials: U
authors.lastname: Persson
mesh_terms: D000293:Adolescent; D000328:Adult; D016026:Bone Marrow Transplantation / Q000276:immunology / Q000379:methods* / Q000401:mortality; D002648:Child; D002675:Child, Preschool; D016572:Cyclosporine / Q000008:administration & dosage*; D004359:Drug Therapy, Combination; D005260:Female; D006086:Graft vs Host Disease / Q000188:drug therapy / Q000517:prevention & control*; D006680:HLA Antigens; D006801:Humans; D007223:Infant; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage*; D008875:Middle Aged; D009369:Neoplasms / Q000188:drug therapy / Q000601:surgery; D015996:Survival Rate
chemical_list: D006680:HLA Antigens; D016572:Cyclosporine; D008727:Methotrexate