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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
R Storb, HJ Deeg, L Fisher, F Appelbaum, CD Buckner, W Bensinger, R Clift, K Doney, C Irle and R McGuffin
Division of Oncology, Fred Hutchinson Cancer Research Center, Seattle, WA
98104.
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.
Volume 71,
Issue 2,
pp. 293-298,
02/01/1988
Copyright © 1988 by The American Society of Hematology
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