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Deletion of immunosuppressive prophylaxis after marrow transplantation increases hyperacute graft-versus-host disease but does not influence chronic graft-versus-host disease or relapse in patients with advanced leukemia

Publication ,  Journal Article
Sullivan, KM; Storb, R; Witherspoon, RP; Weiden, PL; Anasetti, C; Appelbaum, FR; Beatty, P; Buckner, CD; Deeg, HJ; Doney, K; Fisher, L ...
Published in: Clinical Transplantation
January 1, 1989

Sixteen patients < 30 years of age with advanced leukemia who were given unmodified marrow grafts from HLA-identical siblings without posttransplant immunosuppression were compared to 44 age- and disease-matched controls who received methotrexate (MTX) to prevent graft-versus-host disease (GVHD). All 60 patients were prepared with cyclophosphamide (60 mg/kg x 2) and total body irradiation (2.25 Gy daily x 7). Grade 2-4 acute GVHD developed in all 15 engrafted patients not given immunosuppression compared to 10 of 44 engrafted MTX recipients (p < 0.0001). The onset of Grade 2-4 GVHD was hyperacute (median d 8) compared to a median onset at d 18 in the MTX group (p = 0.005). Treatment of hyperacute GVHD with prednisone ± cyclosporine or ATG + cyclosporine produced sustained improvement in 6, response with subsequent flare in 4, and no response in 4 patients. Despite the prevalence of hyperacute GVHD in patients not given immunosuppression, there was no statistically significant difference in the probability of chronic GVHD (31% versus 33%), interstitial pneumonia (47% versus 22%), or recurrent leukemia (41% versus 38%) compared to the MTX recipients. Six patients not given immunosuppression and 19 given MTX survive with a median follow-up of 4.4 (range 3.2-6.4) yr after transplant. The probability of death from causes other than recurrent malignancy was 58% in the no-immunosuppresion and 34% in the MTX group (p = 0.1). Actuarial 3-yr relapse-free survival is 25% and 41%, respectively (p = 0.3). We conclude that deletion of immunosuppression after unmodified HLA-identical marrow transplantation leads to an increase in hyperacute GVHD without apparent influence on chronic GVHD or relapse. Although nonrelapse mortality was higher and relapse-free survival was lower in patients not given immunosuppression, differences did not reach statistical significance in this study.

Duke Scholars

Published In

Clinical Transplantation

ISSN

0902-0063

Publication Date

January 1, 1989

Volume

3

Issue

1

Start / End Page

5 / 11

Related Subject Headings

  • Surgery
  • 3202 Clinical sciences
  • 1103 Clinical Sciences
 

Citation

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Sullivan, K. M., Storb, R., Witherspoon, R. P., Weiden, P. L., Anasetti, C., Appelbaum, F. R., … Thomas, E. D. (1989). Deletion of immunosuppressive prophylaxis after marrow transplantation increases hyperacute graft-versus-host disease but does not influence chronic graft-versus-host disease or relapse in patients with advanced leukemia. Clinical Transplantation, 3(1), 5–11.
Sullivan, K. M., R. Storb, R. P. Witherspoon, P. L. Weiden, C. Anasetti, F. R. Appelbaum, P. Beatty, et al. “Deletion of immunosuppressive prophylaxis after marrow transplantation increases hyperacute graft-versus-host disease but does not influence chronic graft-versus-host disease or relapse in patients with advanced leukemia.” Clinical Transplantation 3, no. 1 (January 1, 1989): 5–11.
Sullivan KM, Storb R, Witherspoon RP, Weiden PL, Anasetti C, Appelbaum FR, Beatty P, Buckner CD, Deeg HJ, Doney K, Fisher L, Loughran TP, Martin P, Meyers J, McDonald GB, Sanders J, Shulman H, Stewart P, Thomas ED. Deletion of immunosuppressive prophylaxis after marrow transplantation increases hyperacute graft-versus-host disease but does not influence chronic graft-versus-host disease or relapse in patients with advanced leukemia. Clinical Transplantation. 1989 Jan 1;3(1):5–11.
Journal cover image

Published In

Clinical Transplantation

ISSN

0902-0063

Publication Date

January 1, 1989

Volume

3

Issue

1

Start / End Page

5 / 11

Related Subject Headings

  • Surgery
  • 3202 Clinical sciences
  • 1103 Clinical Sciences