HIGH-DOSE METHYLPREDNISOLONE TREATMENT FOR ACUTE GRAFT-VERSUS-HOST DISEASE AFTER BONE MARROW TRANSPLANTATION IN ADULTS

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Abstract
High-dose methylprednisolone (HDMP) was used to treat 18 episodes of severe (grades III and IV) acute graft-vs.-host disease (GVHD) that developed after allogeneic bone marrow transplantation in 12 patients with acute leukemia and in 2 with aplastic anemia. Most of the patients showed rapid improvement in GVHD, with complete resolution of the skin and gut manifestations. The response of liver disease to the treatment was slow and incomplete. Complications seen were interstitial pneumonia and fungal and viral infections. Seven patients survived for more than 2 mo. following the treatment of acute GVHD. Of these, 5 became long-term survivors with a median survival of 22+ mo. (range 11-38 mo.); all 5 long-term survivors developed chronic GVHD and are alive at the treatment for severe acute GVHD. Its true efficacy can only be ascertained in a randomized study comparing high-dose and conventional-dose methylprednisolone.