INCIDENCE OF ACUTE GRAFT-VERSUS-HOST DISEASE WITH AND WITHOUT METHOTREXATE PROPHYLAXIS IN ALLOGENEIC BONE-MARROW TRANSPLANT PATIENTS

  • 1 January 1984
    • journal article
    • research article
    • Vol. 64  (1) , 215-220
Abstract
Methotrexate has been used as the mainstay therapy to prevent or ameliorate graft-vs.-host disease (GVHD) in allogeneic bone marrow transplantation. A nonrandomized study was run in which methotrexate was not given routinely. Fifty-five patients underwent transplant for acute leukemia (44 patients), aplastic anemia (6 patients), and other malignancies (5 patients). Methotrexate was given to 34 patients (MTX+) and was withheld in 21 patients (MTX-). Median (range) age of patients was 12 (0.8-43) yr in the MTX+ group, and 16 (3-45) yr in the MTX- group. Mean days (.+-. SEM) to engraftment (neutrophils > 500/.mu.l, and platelets > 20,000/.mu.l untransfused) occurred earlier in the MTX- patients (19.6 .+-. 1.4 vs. 24.9 .+-. 1.8 days for granulocytes, and 19.3 .+-. 1.5 vs. 27.4 .+-. 2.8 days for platelets, P < 0.05). There were no statistically significant differences between the patient groups for the incidence or severity of GVHD (10/34 in the MTX+ group had grade 0-1 GVHD compared to 9/21 in the MTX- group). Interstitial pneumonitis occurred significantly more often in patients who received methotrexate (15/34) compared to those patients who did not (3/21) (P = 0.02) However, there was also a significant relationship between the interstitial pneumonitis and the preparative regimen: if the preparative regimen contained 1000 rad single fraction total body irradiation, 8/14 patients were affected compared to 5/22 patients affected when 1200 rad fractionated total body irradiation was used (P = 0.03). Because methotrexate significantly retards hematopoietic reconstitution, randomized trials for GVHD prevention are recommended.

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