A three or more drug combination as effective therapy for moderate or severe chronic graft-versus-host disease.
We analyzed the results of a three or more drug combination as treatment for moderate or severe cGVHD developing after transplantation for thalassemia, in 45 patients with median age of 11 (range 2-26) years. Eighteen patients received a three drug regimen with cyclosporine (CsA), methylprednisolone (MP) and azathioprine (AZ) as first line therapy, 16 patients received this regimen as salvage therapy and 11 patients were given a four or five drug regimen with CsA, MP, AZ, cyclophosphamide (CY) and/or methotrexate (MTX) mainly as salvage therapy. The overall complete response (CR) rate was 77.3%, with 94% of CR in patients receiving the three drug regimen as first line, 88% in patients receiving it as salvage therapy and 36.6% in patients given the four or five drug regimen. The probability of CR in patients given the three drug regimen as first or salvage therapy or the four/five drug regimen was 89%, 53% and 30%, while the probability of survival was 89%, 65% and 58%, respectively. The incidence of treatment failure was low in our patients. Patients treated with the three drug regimen as first line therapy had less treatment-related complications than patients receiving this regimen as salvage therapy or patients given the four or five drug regimen. The main causes of treatment-related mortality (20%) were infectious complications. This retrospective study showed that a three or more drug combination is safe and effective for treatment of moderate or severe cGVHD at least in younger patients.
Gaziev
D
D
Divisione di Ematologia e Centro Trapianti di Midollo Osseo di Muraglia, Azienda Ospedaliera S Salvatore di Pesaro, Pesaro, Italy.
Lucarelli
G
G
Polchi
P
P
Angelucci
E
E
Galimberti
M
M
Giardini
C
C
Baronciani
D
D
Erer
B
B
Sodani
P
P
D000293:Adolescent; D000328:Adult; D016026:Bone Marrow Transplantation / Q000009:adverse effects / Q000401:mortality; D002648:Child; D002675:Child, Preschool; D018572:Disease-Free Survival; D004359:Drug Therapy, Combination; D005260:Female; D006086:Graft vs Host Disease / Q000188:drug therapy* / Q000401:mortality; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage* / Q000592:standards / Q000633:toxicity; D007239:Infections / Q000139:chemically induced; D008297:Male; D016879:Salvage Therapy / Q000379:methods / Q000401:mortality / Q000592:standards; D013789:Thalassemia / Q000150:complications / Q000628:therapy; D016896:Treatment Outcome
D007166:Immunosuppressive Agents