Tags

Type your tag names separated by a space and hit enter

Early treatment of acute graft-versus-host disease with high- or low-dose 6-methylprednisolone: a multicenter randomized trial from the Italian Group for Bone Marrow Transplantation.

Abstract

Ninety-five patients undergoing an allogeneic bone marrow transplant (BMT) and developing acute graft-versus-host disease (aGvHD) were randomized to receive low-dose intravenous 6-methylprednisolone (6MPred; 2 mg/kg /d; n = 47) or high-dose 6MPred (10 mg/kg/d; n = 48) for 5 days, with subsequent tapering doses. On day 5 patients not responding or progressing on low-dose 6MPred could be switched to high-dose 6MPred. All patients, aged 1 to 55 years, were recipients of unmanipulated BMT from HLA identical sibling donors. Patients were stratified at randomization for age (</>/= 20 years), disease (acute leukemia, chronic myeloid leukemia [CML], nonneoplastic disease), disease status (early/advanced), and GvHD prophylaxis (cyclosporin/cyclosporin + methotrexate). Primary endpoints were response to treatment and evolution of aGvHD to grade III-IV. Secondary endpoints were cytomegalovirus (CMV) infections, transplant-related mortality (TRM), and relapse. The median interval between BMT and treatment was 12 days (6 to 43). Results in the two groups (2 v 10 mg/kg) were as follows: response of aGvHD 68% versus 71% (P = .9), evolution to aGvHD grade III-IV 17% versus 20% (P = . 6), CMV infections 55% versus 60% (P = .7), 3-year actuarial TRM 28% versus 32% (P = .7), relapse 17% versus 7% (P = .1). The actuarial survival at 3 years was 63% versus 62% (P = .9) with a median follow up of 580 and 778 days. On day 5 of therapy, 26 patients assigned to low-dose (2 mg/kg) 6MPred were switched to a higher dose of 6MPred because of no response or progression. Their actuarial TRM was 46%, which is significantly higher than TRM of patients who responded on 2 mg/kg and continued with tapering doses (TRM = 16%, P = .007). In conclusion, early treatment of acute GvHD with 6MPred 10 mg/kg/d does not improve the response rate as compared with 2 mg/kg/d, nor does it prevent evolution to aGvHD grade III-IV. CMV infections, TRM, and survival were also comparable. A group of patients at high risk of TRM can be identified after 5 days of treatment with 6MPred 2 mg/kg and could be eligible for alternative forms of therapy.

Links

  • FREE Publisher Full Text
  • Authors+Show Affiliations

    ,

    Divisione Ematologial, Ospedale San Martino, Genova; Clinica Pediatrica, Milano, Italy.

    , , , , , , , , , , , , , ,

    Source

    Blood 92:7 1998 Oct 01 pg 2288-93

    MeSH

    Actuarial Analysis
    Acute Disease
    Adolescent
    Adult
    Bone Marrow Transplantation
    Cause of Death
    Child
    Child, Preschool
    Cytomegalovirus Infections
    Dose-Response Relationship, Drug
    Female
    Graft vs Host Disease
    Hematologic Neoplasms
    Histocompatibility
    Humans
    Hyperglycemia
    Hypertension
    Immunosuppressive Agents
    Infant
    Infection
    Italy
    Male
    Methylprednisolone
    Middle Aged
    Nuclear Family
    Prospective Studies
    Recurrence
    Survival Analysis
    Tissue Donors
    Transplantation Conditioning
    Transplantation, Homologous
    Treatment Outcome

    Pub Type(s)

    Clinical Trial
    Comparative Study
    Journal Article
    Multicenter Study
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

    Language

    eng

    PubMed ID

    9746766

    Citation

    Van Lint, M T., et al. "Early Treatment of Acute Graft-versus-host Disease With High- or Low-dose 6-methylprednisolone: a Multicenter Randomized Trial From the Italian Group for Bone Marrow Transplantation." Blood, vol. 92, no. 7, 1998, pp. 2288-93.
    Van Lint MT, Uderzo C, Locasciulli A, et al. Early treatment of acute graft-versus-host disease with high- or low-dose 6-methylprednisolone: a multicenter randomized trial from the Italian Group for Bone Marrow Transplantation. Blood. 1998;92(7):2288-93.
    Van Lint, M. T., Uderzo, C., Locasciulli, A., Majolino, I., Scimé, R., Locatelli, F., ... Bacigalupo, A. (1998). Early treatment of acute graft-versus-host disease with high- or low-dose 6-methylprednisolone: a multicenter randomized trial from the Italian Group for Bone Marrow Transplantation. Blood, 92(7), pp. 2288-93.
    Van Lint MT, et al. Early Treatment of Acute Graft-versus-host Disease With High- or Low-dose 6-methylprednisolone: a Multicenter Randomized Trial From the Italian Group for Bone Marrow Transplantation. Blood. 1998 Oct 1;92(7):2288-93. PubMed PMID: 9746766.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Early treatment of acute graft-versus-host disease with high- or low-dose 6-methylprednisolone: a multicenter randomized trial from the Italian Group for Bone Marrow Transplantation. AU - Van Lint,M T, AU - Uderzo,C, AU - Locasciulli,A, AU - Majolino,I, AU - Scimé,R, AU - Locatelli,F, AU - Giorgiani,G, AU - Arcese,W, AU - Iori,A P, AU - Falda,M, AU - Bosi,A, AU - Miniero,R, AU - Alessandrino,P, AU - Dini,G, AU - Rotoli,B, AU - Bacigalupo,A, PY - 1998/9/25/pubmed PY - 1998/9/25/medline PY - 1998/9/25/entrez SP - 2288 EP - 93 JF - Blood JO - Blood VL - 92 IS - 7 N2 - Ninety-five patients undergoing an allogeneic bone marrow transplant (BMT) and developing acute graft-versus-host disease (aGvHD) were randomized to receive low-dose intravenous 6-methylprednisolone (6MPred; 2 mg/kg /d; n = 47) or high-dose 6MPred (10 mg/kg/d; n = 48) for 5 days, with subsequent tapering doses. On day 5 patients not responding or progressing on low-dose 6MPred could be switched to high-dose 6MPred. All patients, aged 1 to 55 years, were recipients of unmanipulated BMT from HLA identical sibling donors. Patients were stratified at randomization for age (</>/= 20 years), disease (acute leukemia, chronic myeloid leukemia [CML], nonneoplastic disease), disease status (early/advanced), and GvHD prophylaxis (cyclosporin/cyclosporin + methotrexate). Primary endpoints were response to treatment and evolution of aGvHD to grade III-IV. Secondary endpoints were cytomegalovirus (CMV) infections, transplant-related mortality (TRM), and relapse. The median interval between BMT and treatment was 12 days (6 to 43). Results in the two groups (2 v 10 mg/kg) were as follows: response of aGvHD 68% versus 71% (P = .9), evolution to aGvHD grade III-IV 17% versus 20% (P = . 6), CMV infections 55% versus 60% (P = .7), 3-year actuarial TRM 28% versus 32% (P = .7), relapse 17% versus 7% (P = .1). The actuarial survival at 3 years was 63% versus 62% (P = .9) with a median follow up of 580 and 778 days. On day 5 of therapy, 26 patients assigned to low-dose (2 mg/kg) 6MPred were switched to a higher dose of 6MPred because of no response or progression. Their actuarial TRM was 46%, which is significantly higher than TRM of patients who responded on 2 mg/kg and continued with tapering doses (TRM = 16%, P = .007). In conclusion, early treatment of acute GvHD with 6MPred 10 mg/kg/d does not improve the response rate as compared with 2 mg/kg/d, nor does it prevent evolution to aGvHD grade III-IV. CMV infections, TRM, and survival were also comparable. A group of patients at high risk of TRM can be identified after 5 days of treatment with 6MPred 2 mg/kg and could be eligible for alternative forms of therapy. SN - 0006-4971 UR - https://www.unboundmedicine.com/medline/citation/9746766/Early_treatment_of_acute_graft_versus_host_disease_with_high__or_low_dose_6_methylprednisolone:_a_multicenter_randomized_trial_from_the_Italian_Group_for_Bone_Marrow_Transplantation_ L2 - http://www.bloodjournal.org/cgi/pmidlookup?view=long&amp;pmid=9746766 DB - PRIME DP - Unbound Medicine ER -