Cyclosporine v methotrexate for graft-v-host disease prevention in patients given marrow grafts for leukemia: long-term follow-up of three controlled trials.
One hundred seventy-nine patients with acute nonlymphoblastic leukemia in first remission (n = 75), chronic myelocytic leukemia in chronic or accelerated phase (n = 48) or leukemia in advanced stage (n = 56) were given HLA-identical marrow grafts and randomized to receive methotrexate or cyclosporine for prevention of graft-v-host disease (GVHD). The current report updates the three prospective trials with follow-ups ranging from 3.2 to 6.2 years after marrow grafting. Results were analyzed separately for each individual study and for all three studies combined. Overall, 40% of patients given cyclosporine and 55% of those given methotrexate developed acute GVHD (P = .13); the incidence of chronic GVHD was 42% and 48%, respectively (P = .67). Twenty-two percent of cyclosporine-treated patients and 30% of methotrexate-treated patients developed interstitial pneumonia of any etiology (P = .25), and the figures for cytomegalovirus pneumonia were 18% and 20%, respectively (P = .41). The overall incidence of leukemic relapse was 31% in cyclosporine-treated patients and 36% in methotrexate-treated patients (P = .75). The probabilities of survival for cyclosporine-v methotrexate-treated patients were comparable for all three study groups: 52% v 48% in patients with acute nonlymphoblastic leukemia (P = .42), 55% v 60% for those with chronic myelocytic leukemia (P = .61), 12% and 12% for those with advanced leukemia (P = .93), and 39% v 38% overall (P = .72). We conclude that cyclosporine and methotrexate are comparable regarding the likelihood of acute/chronic GVHD, interstitial pneumonia, leukemic relapse, and long-term survival.
Storb
R
R
Division of Oncology, Fred Hutchinson Cancer Research Center, Seattle, WA 98104.
Deeg
H J
HJ
Fisher
L
L
Appelbaum
F
F
Buckner
C D
CD
Bensinger
W
W
Clift
R
R
Doney
K
K
Irle
C
C
McGuffin
R
R
D000208:Acute Disease; D016026:Bone Marrow Transplantation; D002908:Chronic Disease; D003524:Cyclosporins / Q000627:therapeutic use*; D005500:Follow-Up Studies; D006086:Graft vs Host Disease / Q000517:prevention & control*; D006801:Humans; D007938:Leukemia / Q000628:therapy*; D008727:Methotrexate / Q000627:therapeutic use*; D011379:Prognosis; D011446:Prospective Studies; D011658:Pulmonary Fibrosis / Q000209:etiology
D003524:Cyclosporins; D008727:Methotrexate