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Blood, 26 March 2009, Vol. 113, No. 13, pp. 2888-2894. Prepublished online as a Blood First Edition Paper on November 10, 2008; DOI 10.1182/blood-2008-07-168401. This Article Full Text Full Text (PDF) Supplemental Tables and Figures All Versions of this Article: blood-2008-07-168401v1 113/13/2888    most recent Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Rights and Permissions Citing Articles Citing Articles via HighWire Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Mielcarek, M. Articles by Martin, P. J. Search for Related Content PubMed PubMed Citation Articles by Mielcarek, M. Articles by Martin, P. J. Related Collections Transplantation Free Research Articles Clinical Trials and Observations Related Article in Blood Online Social Bookmarking                   What's this?  Previous Article  |  Table of Contents  |  Next Article  CLINICAL TRIALS AND OBSERVATIONS Initial therapy of acute graft-versus-host disease with low-dose prednisone does not compromise patient outcomes Marco Mielcarek1,2, Barry E. Storer1,3,4, Michael Boeckh1,2, Paul A. Carpenter1,2, George B. McDonald1,2, H. Joachim Deeg1,2, Richard A. Nash1,2, Mary E. D. Flowers1,2, Kristine Doney1,2, Stephanie Lee1,2, Kieren A. Marr1,2, Terry Furlong1, Rainer Storb1,2, Frederick R. Appelbaum1,2, and Paul J. Martin1,2 1 Division of Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, WA; 2 Department of Medicine, University of Washington School of Medicine, Seattle; 3 Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA; and 4 Department of Biostatistics, University of Washington School of Medicine, Seattle We hypothesized that initial treatment of acute graft-versus-host disease (GVHD) with low-dose glucocorticoids (prednisone-equivalent dose of 1 mg/kg per day) instead of standard-dose glucocorticoids (prednisone-equivalent dose of 2 mg/kg per day) does not compromise major transplantation outcomes. We retrospectively analyzed outcomes among 733 patients who received transplants between 2000 and 2005 according to initial treatment with low-dose (n = 347) versus standard-dose (n = 386) systemic glucocorticoids. The mean cumulative prednisone-equivalent doses at day 100 after starting treatment were 44 and 87 mg/kg for patients given low-dose and standard-dose glucocorticoids, respectively. Adjusted outcomes between the groups given low-dose versus standard-dose glucocorticoids were not statistically significantly different: overall mortality (hazard ratio [HR], 1.10; 95% confidence interval [CI], 0.9-1.4), relapse (HR, 1.22; 95% CI, 0.9-1.7), nonrelapse mortality (HR, 1.06; 95% CI, 0.8-1.5). The small number of patients with grades III/IV acute GVHD at onset precluded definitive conclusions for this subgroup. In multivariate analysis, the risks of invasive fungal infections (HR, 0.59; 95% CI, 0.3-1.0) and the duration of hospitalization (odds ratio, 0.62; 95% CI, 0.4-0.9) were reduced in the low-dose prednisone group. We conclude that initial treatment with low-dose glucocorticoids for patients with grades I-II GVHD did not compromise disease control or mortality and was associated with decreased toxicity. CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this? Related Article in Blood Online: Where is the start line? Margaret L. MacMillan Blood 2009 113: 2872-2873. [Full Text] [PDF] This article has been cited by other articles: A. M. Alousi, D. J. Weisdorf, B. R. Logan, J. Bolanos-Meade, S. Carter, N. DiFronzo, M. Pasquini, S. C. Goldstein, V. T. Ho, B. Hayes-Lattin, et al. Etanercept, mycophenolate, denileukin, or pentostatin plus corticosteroids for acute graft-versus-host disease: a randomized phase 2 trial from the Blood and Marrow Transplant Clinical Trials Network Blood, July 16, 2009; 114(3): 511 - 517. [Abstract] [Full Text] [PDF] M. L. MacMillan Where is the start line? Blood, March 26, 2009; 113(13): 2872 - 2873. [Full Text] [PDF]

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