Outcome of bone marrow transplantation from HLA-identical sibling donor in children with hematological malignancies using methotrexate alone as prophylaxis for graft-versus-host disease.
Most previous studies of graft-versus-host disease (GVHD) prophylaxis with methotrexate (MTX) alone in patients undergoing HLA-identical sibling donor bone marrow transplantation were performed in adults. With this background, we attempted to analyze the incidence and risk factors of GVHD in bone marrow transplantation (BMT) from an HLA-identical sibling donor in children with hematological malignancies using MTX alone as a prophylaxis for GVHD. Ninety-four patients received MTX by intravenous bolus injection, with a dose of 15 mg/m(2) on day +1, followed by 10 mg/m(2) on days +3, +6, and +11, and then weekly until day +60. The probability of developing grade II-IV acute GVHD and chronic GVHD was 19.1 and 31.8%, respectively. Age at transplantation and a female donor to male recipient were identified as risk factors for chronic GVHD in multivariate analysis, but no factors were identified for acute GVHD. The cumulative incidence of transplant-related mortality during the first 100 days was 9.6%. Disease-free survival at 5 years for standard- and high-risk patients was 82.1 and 39.5%, respectively. These results suggest that GVHD prophylaxis with MTX alone is safe and effective in young children under 10 years old at transplantation and in a setting other than female donor to male recipient.
Watanabe
Nobuhiro
N
Division of Hematology and Oncology, Children's Medical Center, Japanese Red Cross Nagoya First Hospital, Nagoya, Japan. watanabn@nnh.hosp.go.jp.|Clinical Research Center, National Hospital Organization Nagoya Medical Center, 4-1-1 Sannomaru, Naka-ku, Nagoya, Aichi, 461-0001, Japan. watanabn@nnh.hosp.go.jp.
Matsumoto
Kimikazu
K
Division of Hematology and Oncology, Children's Medical Center, Japanese Red Cross Nagoya First Hospital, Nagoya, Japan.
Yoshimi
Ayami
A
Department of HSCT Data Management, Nagoya University, School of Medicine, Nagoya, Japan.
Horibe
Keizo
K
Clinical Research Center, National Hospital Organization Nagoya Medical Center, 4-1-1 Sannomaru, Naka-ku, Nagoya, Aichi, 461-0001, Japan.
Matsuyama
Takaharu
T
Nagoya Nishi Clinic Hospital, Nagoya, Japan.
Kojima
Seiji
S
Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Kato
Koji
K
Division of Hematology and Oncology, Children's Medical Center, Japanese Red Cross Nagoya First Hospital, Nagoya, Japan.
D000208:Acute Disease; D000293:Adolescent; D000964:Antimetabolites, Antineoplastic / Q000008:administration & dosage*; D016026:Bone Marrow Transplantation; D002648:Child; D002675:Child, Preschool; D018572:Disease-Free Survival; D005260:Female; D006086:Graft vs Host Disease / Q000401:mortality* / Q000517:prevention & control*; D006680:HLA Antigens; D019337:Hematologic Neoplasms / Q000401:mortality* / Q000628:therapy; D006801:Humans; D015994:Incidence; D007223:Infant; D019520:Living Donors; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage*; D012189:Retrospective Studies; D012307:Risk Factors; D035781:Siblings; D015996:Survival Rate
D000964:Antimetabolites, Antineoplastic; D006680:HLA Antigens; D008727:Methotrexate