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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.
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Submitted July 14, 2008
Accepted November 1, 2008
Initial therapy of acute graft-versus-host disease with "low-dose" prednisone does not compromise patient outcomes
Marco Mielcarek*, Barry E Storer, Michael J. Boeckh, Paul A. Carpenter, George B. McDonald, H Joachim Deeg, Richard A. Nash, Mary E.D. Flowers, Kristine Doney, Stephanie Lee, Kieren A Marr, Terry Furlong, Rainer Storb, Frederick R Appelbaum, and Paul J Martin
Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, United States
Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA, United States
Department of Medicine, University of Washington School of Medicine, Seattle, WA, United States
* Corresponding author; email: mielcar{at}u.washington.edu.
We hypothesized that initial treatment of acute graft-versus-host disease (GVHD) with "low-dose" glucocorticoids (prednisone-equivalent dose of 1 mg/kg/day) instead of "standard-dose" glucocorticoids (prednisone-equivalent dose of 2 mg/kg/day) does not compromise major transplantation outcomes. We therefore retrospectively analyzed outcomes among 733 patients transplanted at a single institution 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 mg/kg 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), non-relapse mortality (HR, 1.06; 95% CI, 0.8-1.5). The relatively small number of patients with grades III/IV acute GVHD at the onset of glucocorticoid treatment 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.
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