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Initial therapy of acute graft-versus-host disease with low-dose prednisone does not compromise patient outcomes

By Marco Mielcarek, Barry E. Storer, Michael 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

Abstract

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

Topics: Clinical Trials and Observations
Publisher: American Society of Hematology
OAI identifier: oai:pubmedcentral.nih.gov:2662636
Provided by: PubMed Central
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