Newly diagnosed patients with acute graft-versus-host disease (GvHD, grades I-IV; n = 211) were given 6-methylprednisolone (6MPred) 2 mg/kg per day for 5 consecutive days; 150 patients (71%) tapered 6MPred on day +5 and were considered responders; 61 patients (29%) could not taper their steroid dose and were considered nonresponders. The cumulative incidence of transplant-related mortality (TRM) for responders and nonresponders is, respectively, 27% and 49% (P = .009), and the 5-year survival is 53% and 35% (P = .007). Nonresponders on day +5 (n = 61) were randomized to receive 6MPred 5 mg/kg per day for 10 days alone (n = 34) or in combination with rabbit anti-thymocyte globulin (ATG, 6.25 mg/kg in 10 days; n = 27). The 2 groups were balanced for clinical and GvHD characteristics. One month after randomization, 26% had a complete response; 23%, a partial response; 33%, stable GvHD; 10%, worsened; and 8%, died. There was no significant difference in response, TRM, and survival between the non-ATG and ATG group. In conclusion, 5 days of prednisolone as first-line therapy of acute GvHD identifies patients with different risk of TRM, and second-line therapy with a combination of 6MPred + ATG does not improve patient outcome, compared with 6MPred alone.

Van Lint, M., Milone, G., Leotta, S., Uderzo, C., Scime, R., Dallorso, S., et al. (2006). Treatment of acute graft-versus-host disease with prednisolone: significant survival advantage for day+5 responders and no advantage for nonresponders receiving anti-thymocyte globulin. BLOOD, 107(10), 4177-4181 [10.1182/blood-2005-12-4851].

Treatment of acute graft-versus-host disease with prednisolone: significant survival advantage for day+5 responders and no advantage for nonresponders receiving anti-thymocyte globulin

CUDILLO, LAURA;ARCESE, WILLIAM;
2006-01-01

Abstract

Newly diagnosed patients with acute graft-versus-host disease (GvHD, grades I-IV; n = 211) were given 6-methylprednisolone (6MPred) 2 mg/kg per day for 5 consecutive days; 150 patients (71%) tapered 6MPred on day +5 and were considered responders; 61 patients (29%) could not taper their steroid dose and were considered nonresponders. The cumulative incidence of transplant-related mortality (TRM) for responders and nonresponders is, respectively, 27% and 49% (P = .009), and the 5-year survival is 53% and 35% (P = .007). Nonresponders on day +5 (n = 61) were randomized to receive 6MPred 5 mg/kg per day for 10 days alone (n = 34) or in combination with rabbit anti-thymocyte globulin (ATG, 6.25 mg/kg in 10 days; n = 27). The 2 groups were balanced for clinical and GvHD characteristics. One month after randomization, 26% had a complete response; 23%, a partial response; 33%, stable GvHD; 10%, worsened; and 8%, died. There was no significant difference in response, TRM, and survival between the non-ATG and ATG group. In conclusion, 5 days of prednisolone as first-line therapy of acute GvHD identifies patients with different risk of TRM, and second-line therapy with a combination of 6MPred + ATG does not improve patient outcome, compared with 6MPred alone.
2006
Pubblicato
Rilevanza internazionale
Articolo
Esperti anonimi
Settore MED/15 - MALATTIE DEL SANGUE
English
Con Impact Factor ISI
STEROID-REFRACTORY ACUTE; BONE-MARROW-TRANSPLANTATION; STEM-CELL TRANSPLANTATION; RANDOMIZED-TRIAL; ALPHA ANTIBODY; THERAPY; INFLIXIMAB; DACLIZUMAB; MORTALITY
5
Van Lint, M., Milone, G., Leotta, S., Uderzo, C., Scime, R., Dallorso, S., et al. (2006). Treatment of acute graft-versus-host disease with prednisolone: significant survival advantage for day+5 responders and no advantage for nonresponders receiving anti-thymocyte globulin. BLOOD, 107(10), 4177-4181 [10.1182/blood-2005-12-4851].
Van Lint, M; Milone, G; Leotta, S; Uderzo, C; Scime, R; Dallorso, S; Locasciulli, A; Guidi, S; Mordini, N; Sica, S; Cudillo, L; Fagioli, F; Selleri, C; Bruno, B; Arcese, W; Bacigalupo, A
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/2108/57360
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