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Cyclosporine v methotrexate for graft-v-host disease prevention in patients given marrow grafts for leukemia: long-term follow-up of three controlled trials.

Publication ,  Journal Article
Storb, R; Deeg, HJ; Fisher, L; Appelbaum, F; Buckner, CD; Bensinger, W; Clift, R; Doney, K; Irle, C; McGuffin, R
Published in: Blood
February 1988

One hundred seventy-nine patients with acute nonlymphoblastic leukemia in first remission (n = 75), chronic myelocytic leukemia in chronic or accelerated phase (n = 48) or leukemia in advanced stage (n = 56) were given HLA-identical marrow grafts and randomized to receive methotrexate or cyclosporine for prevention of graft-v-host disease (GVHD). The current report updates the three prospective trials with follow-ups ranging from 3.2 to 6.2 years after marrow grafting. Results were analyzed separately for each individual study and for all three studies combined. Overall, 40% of patients given cyclosporine and 55% of those given methotrexate developed acute GVHD (P = .13); the incidence of chronic GVHD was 42% and 48%, respectively (P = .67). Twenty-two percent of cyclosporine-treated patients and 30% of methotrexate-treated patients developed interstitial pneumonia of any etiology (P = .25), and the figures for cytomegalovirus pneumonia were 18% and 20%, respectively (P = .41). The overall incidence of leukemic relapse was 31% in cyclosporine-treated patients and 36% in methotrexate-treated patients (P = .75). The probabilities of survival for cyclosporine-v methotrexate-treated patients were comparable for all three study groups: 52% v 48% in patients with acute nonlymphoblastic leukemia (P = .42), 55% v 60% for those with chronic myelocytic leukemia (P = .61), 12% and 12% for those with advanced leukemia (P = .93), and 39% v 38% overall (P = .72). We conclude that cyclosporine and methotrexate are comparable regarding the likelihood of acute/chronic GVHD, interstitial pneumonia, leukemic relapse, and long-term survival.

Duke Scholars

Published In

Blood

ISSN

0006-4971

Publication Date

February 1988

Volume

71

Issue

2

Start / End Page

293 / 298

Location

United States

Related Subject Headings

  • Pulmonary Fibrosis
  • Prospective Studies
  • Prognosis
  • Methotrexate
  • Leukemia
  • Immunology
  • Humans
  • Graft vs Host Disease
  • Follow-Up Studies
  • Cyclosporins
 

Citation

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MLA
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Storb, R., Deeg, H. J., Fisher, L., Appelbaum, F., Buckner, C. D., Bensinger, W., … McGuffin, R. (1988). Cyclosporine v methotrexate for graft-v-host disease prevention in patients given marrow grafts for leukemia: long-term follow-up of three controlled trials. Blood, 71(2), 293–298.
Storb, R., H. J. Deeg, L. Fisher, F. Appelbaum, C. D. Buckner, W. Bensinger, R. Clift, K. Doney, C. Irle, and R. McGuffin. “Cyclosporine v methotrexate for graft-v-host disease prevention in patients given marrow grafts for leukemia: long-term follow-up of three controlled trials.Blood 71, no. 2 (February 1988): 293–98.
Storb R, Deeg HJ, Fisher L, Appelbaum F, Buckner CD, Bensinger W, Clift R, Doney K, Irle C, McGuffin R. Cyclosporine v methotrexate for graft-v-host disease prevention in patients given marrow grafts for leukemia: long-term follow-up of three controlled trials. Blood. 1988 Feb;71(2):293–298.

Published In

Blood

ISSN

0006-4971

Publication Date

February 1988

Volume

71

Issue

2

Start / End Page

293 / 298

Location

United States

Related Subject Headings

  • Pulmonary Fibrosis
  • Prospective Studies
  • Prognosis
  • Methotrexate
  • Leukemia
  • Immunology
  • Humans
  • Graft vs Host Disease
  • Follow-Up Studies
  • Cyclosporins