title: Initial therapy of acute graft-versus-host disease with low-dose prednisone does not compromise patient outcomes.
abstract: We hypothesized that initial treatment of acute graft-versus-host disease (GVHD) with low-dose glucocorticoids (prednisone-equivalent dose of 1 mg/kg per day) instead of standard-dose glucocorticoids (prednisone-equivalent dose of 2 mg/kg per day) does not compromise major transplantation outcomes. We retrospectively analyzed outcomes among 733 patients who received transplants between 2000 and 2005 according to initial treatment with low-dose (n=347) versus standard-dose (n=386) systemic glucocorticoids. The mean cumulative prednisone-equivalent doses at day 100 after starting treatment were 44 and 87 mg/kg for patients given low-dose and standard-dose glucocorticoids, respectively. Adjusted outcomes between the groups given low-dose versus standard-dose glucocorticoids were not statistically significantly different: overall mortality (hazard ratio [HR], 1.10; 95% confidence interval [CI], 0.9-1.4), relapse (HR, 1.22; 95% CI, 0.9-1.7), nonrelapse mortality (HR, 1.06; 95% CI, 0.8-1.5). The small number of patients with grades III/IV acute GVHD at onset precluded definitive conclusions for this subgroup. In multivariate analysis, the risks of invasive fungal infections (HR, 0.59; 95% CI, 0.3-1.0) and the duration of hospitalization (odds ratio, 0.62; 95% CI, 0.4-0.9) were reduced in the low-dose prednisone group. We conclude that initial treatment with low-dose glucocorticoids for patients with grades I-II GVHD did not compromise disease control or mortality and was associated with decreased toxicity.
authors.affiliation: Division of Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, WA 98109-1024, USA. mielcar@fhcrc.org
authors.forename: Marco
authors.initials: M
authors.lastname: Mielcarek
authors.forename: Barry E
authors.initials: BE
authors.lastname: Storer
authors.forename: Michael
authors.initials: M
authors.lastname: Boeckh
authors.forename: Paul A
authors.initials: PA
authors.lastname: Carpenter
authors.forename: George B
authors.initials: GB
authors.lastname: McDonald
authors.forename: H Joachim
authors.initials: HJ
authors.lastname: Deeg
authors.forename: Richard A
authors.initials: RA
authors.lastname: Nash
authors.forename: Mary E D
authors.initials: ME
authors.lastname: Flowers
authors.forename: Kristine
authors.initials: K
authors.lastname: Doney
authors.forename: Stephanie
authors.initials: S
authors.lastname: Lee
authors.forename: Kieren A
authors.initials: KA
authors.lastname: Marr
authors.forename: Terry
authors.initials: T
authors.lastname: Furlong
authors.forename: Rainer
authors.initials: R
authors.lastname: Storb
authors.forename: Frederick R
authors.initials: FR
authors.lastname: Appelbaum
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Martin
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D004305:Dose-Response Relationship, Drug; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage; D006086:Graft vs Host Disease / Q000188:drug therapy*; D019337:Hematologic Neoplasms / Q000628:therapy; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D011241:Prednisone / Q000008:administration & dosage*; D012189:Retrospective Studies; D019172:Transplantation Conditioning / Q000379:methods; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D005938:Glucocorticoids; D011241:Prednisone