Published in:
01-06-2015 | Original Article – Clinical Oncology
Superior outcome using cyclosporin A alone versus cyclosporin A plus methotrexate for post-transplant immunosuppression in children with acute leukemia undergoing sibling hematopoietic stem cell transplantation
Published in: Journal of Cancer Research and Clinical Oncology | Issue 6/2015
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Purpose
The outcome of cyclosporin A (CSA) alone (n = 19) as graft-versus-host disease (GVHD) prophylaxis was compared to that of CSA combined with methotrexate (MTX) (n = 43) in children with acute leukemia who underwent hematopoietic stem cell transplantation.
Methods
All respective donors were HLA-identical siblings. All patients received CSA at a dose of 3 mg/kg/day starting on day −1. A CSA level of 80–130 ng/ml was aimed for. The 43 patients in the historical control were given an additional 10 mg/m2 dosage of MTX on days 1, 3, 6, and 11.
Results
Patients who received CSA alone had a significantly reduced cumulative incidence of relapse (5 vs. 40 %; p = 0.002), a significantly increased 5-year event-free survival (84 vs. 35 %; p = 0.001), and a significantly increased 5-year overall survival (84 vs. 42 %; p = 0.004). The incidence of acute GVHD grade II–IV and chronic GVHD in patients in the CSA group was equivalent to the CSA+MTX group (26 vs. 19 %; p = 0.440, and 32 vs. 23 %; p = 0.428).
Conclusions
In conclusion, post-transplant immunosuppression consisting of CSA alone is well tolerated and may contribute to a superior outcome.