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Effect of graft-versus-host disease prophylaxis on relapse in patients transplanted for acute myeloid leukemia.

Publication ,  Journal Article
Weaver, CH; Clift, RA; Deeg, HJ; Storb, R; Appelbaum, FR; Bensinger, W; Doney, K; Hansen, JA; Martin, PO; Sanders, J
Published in: Bone Marrow Transplant
December 1994

Between November 1978 and September 1988, 184 patients with acute myeloid leukemia in first remission received marrow transplants from HLA-identical siblings after conditioning with 120 mg/kg of cyclophosphamide and 12.0 Gy fractionated total body irradiation. Patients received either cyclosporine (CYA, n = 59), methotrexate (MTX, n = 82), or MTX + CYA (n = 43 as graft-versus-host disease (GVHD) prophylaxis. The probabilities of grades II-IV acute GVHD after CYA, MTX or MTX+CYA were 0.43, 0.48 and 0.28, respectively (p = 0.06). The probability of non-relapse mortality was 0.53, 0.50 and 0.42 at 4 years in patients treated with CYA, MTX, or MTX + CYA, respectively. The probability of relapse was 0.24 in patients receiving CYA, 0.24 in patients receiving MTX and 0.44 in patients receiving MTX + CYA (p = 0.02). The probability of survival at 4 years was 0.54 with CYA, 0.51 with MTX and 0.45 with MTX + CYA. A multivariate analysis of risk factors for relapse examined age, WBC at diagnosis, blast count at diagnosis, percentage of marrow blasts, FAB subtype, the number of remission induction courses to achieve a remission, maintenance therapy, consolidation therapy, marrow cell dose, donor-recipient sex, GVHD prophylaxis regimen and isolation and decontamination in laminar airflow rooms. GVHD prophylaxis with MTX + CYA was independently significantly associated with an increased risk of relapse (relative risk 2.25, p = 0.01). Acute GVHD was associated with increased non-relapse mortality (RR = 3.58, p < 0.0001). The administration of MTX + CYA did not adversely affect survival because patients receiving this regimen experienced less mortality from causes other than relapse when compared with patients receiving either CYA or MTX alone.

Duke Scholars

Published In

Bone Marrow Transplant

ISSN

0268-3369

Publication Date

December 1994

Volume

14

Issue

6

Start / End Page

885 / 893

Location

England

Related Subject Headings

  • Survival Analysis
  • Retrospective Studies
  • Multivariate Analysis
  • Methotrexate
  • Male
  • Leukemia, Myeloid
  • Infant
  • Immunology
  • Humans
  • Graft vs Host Disease
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Weaver, C. H., Clift, R. A., Deeg, H. J., Storb, R., Appelbaum, F. R., Bensinger, W., … Sanders, J. (1994). Effect of graft-versus-host disease prophylaxis on relapse in patients transplanted for acute myeloid leukemia. Bone Marrow Transplant, 14(6), 885–893.
Weaver, C. H., R. A. Clift, H. J. Deeg, R. Storb, F. R. Appelbaum, W. Bensinger, K. Doney, J. A. Hansen, P. O. Martin, and J. Sanders. “Effect of graft-versus-host disease prophylaxis on relapse in patients transplanted for acute myeloid leukemia.Bone Marrow Transplant 14, no. 6 (December 1994): 885–93.
Weaver CH, Clift RA, Deeg HJ, Storb R, Appelbaum FR, Bensinger W, et al. Effect of graft-versus-host disease prophylaxis on relapse in patients transplanted for acute myeloid leukemia. Bone Marrow Transplant. 1994 Dec;14(6):885–93.
Weaver, C. H., et al. “Effect of graft-versus-host disease prophylaxis on relapse in patients transplanted for acute myeloid leukemia.Bone Marrow Transplant, vol. 14, no. 6, Dec. 1994, pp. 885–93.
Weaver CH, Clift RA, Deeg HJ, Storb R, Appelbaum FR, Bensinger W, Doney K, Hansen JA, Martin PO, Sanders J. Effect of graft-versus-host disease prophylaxis on relapse in patients transplanted for acute myeloid leukemia. Bone Marrow Transplant. 1994 Dec;14(6):885–893.

Published In

Bone Marrow Transplant

ISSN

0268-3369

Publication Date

December 1994

Volume

14

Issue

6

Start / End Page

885 / 893

Location

England

Related Subject Headings

  • Survival Analysis
  • Retrospective Studies
  • Multivariate Analysis
  • Methotrexate
  • Male
  • Leukemia, Myeloid
  • Infant
  • Immunology
  • Humans
  • Graft vs Host Disease