Incidence of acute graft-versus-host disease with and without methotrexate prophylaxis in allogeneic bone marrow transplant patients

H. M. Lazarus, Peter Felix Coccia, R. H. Herzig, J. Graham-Pole, S. Gross, S. Strandjord, E. Gordon, N. K. Cheung, Phyllis Irene Warkentin, T. R. Spitzer

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Abstract

Methotrexate has been used as the mainstay therapy to prevent or ameliorate graft-versus-host disease (GVHD) in allogeneic bone marrow transplantation. We began a nonrandomized study in which methotrexate was not given routinely. Fifty-five patients underwent transplant for acute leukemia (44 patients), asplastic 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) years in the MTX+ group, and 16 (3-45) years in the MTX- group. Mean days (±SEM) to engraftment (neutrophils >500/μL, and platelets >20,000/μL untransfused) occurred earlier in the MTX- patients (19.6 2+ 1.4 v 24.9 ± 1.8 days for granulocytes, and 19.3 ± 1.5 27.4 ± 2.8 days for platelets, P < .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-I GVHD compared to 9/21 in the MTX- group). The interstitial pneumonitis occurred at a significantly increased rate in patients who received methotrexate (15/34) compared to those patients who did not (3/21) (P = .02). However, there was also a significant relationship between the interstitial pneumonitis and the preparative regimen: if the preparative regimen contained 1,000 rad single fraction total body irradiation, 8/14 patients were affected compared to 5/22 patients affected when 1,200 rad fractionated total body irradiation was used (P = .03). Because methotrexate significantly retards hematopoietic reconstitution, randomized trials for GVHD prevention are recommended.

Original languageEnglish (US)
Pages (from-to)215-220
Number of pages6
JournalBlood
Volume64
Issue number1
StatePublished - Aug 30 1984

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Transplants
Graft vs Host Disease
Methotrexate
Grafts
Bone
Bone Marrow
Incidence
Platelets
Irradiation
Whole-Body Irradiation
Interstitial Lung Diseases
Scanning electron microscopy
Blood Platelets
Homologous Transplantation
Bone Marrow Transplantation
Granulocytes
Anemia
Leukemia
Neutrophils

ASJC Scopus subject areas

  • Biochemistry
  • Immunology
  • Hematology
  • Cell Biology

Cite this

Lazarus, H. M., Coccia, P. F., Herzig, R. H., Graham-Pole, J., Gross, S., Strandjord, S., ... Spitzer, T. R. (1984). Incidence of acute graft-versus-host disease with and without methotrexate prophylaxis in allogeneic bone marrow transplant patients. Blood, 64(1), 215-220.

Incidence of acute graft-versus-host disease with and without methotrexate prophylaxis in allogeneic bone marrow transplant patients. / Lazarus, H. M.; Coccia, Peter Felix; Herzig, R. H.; Graham-Pole, J.; Gross, S.; Strandjord, S.; Gordon, E.; Cheung, N. K.; Warkentin, Phyllis Irene; Spitzer, T. R.

In: Blood, Vol. 64, No. 1, 30.08.1984, p. 215-220.

Research output: Contribution to journalArticle

Lazarus, HM, Coccia, PF, Herzig, RH, Graham-Pole, J, Gross, S, Strandjord, S, Gordon, E, Cheung, NK, Warkentin, PI & Spitzer, TR 1984, 'Incidence of acute graft-versus-host disease with and without methotrexate prophylaxis in allogeneic bone marrow transplant patients', Blood, vol. 64, no. 1, pp. 215-220.
Lazarus HM, Coccia PF, Herzig RH, Graham-Pole J, Gross S, Strandjord S et al. Incidence of acute graft-versus-host disease with and without methotrexate prophylaxis in allogeneic bone marrow transplant patients. Blood. 1984 Aug 30;64(1):215-220.
Lazarus, H. M. ; Coccia, Peter Felix ; Herzig, R. H. ; Graham-Pole, J. ; Gross, S. ; Strandjord, S. ; Gordon, E. ; Cheung, N. K. ; Warkentin, Phyllis Irene ; Spitzer, T. R. / Incidence of acute graft-versus-host disease with and without methotrexate prophylaxis in allogeneic bone marrow transplant patients. In: Blood. 1984 ; Vol. 64, No. 1. pp. 215-220.
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abstract = "Methotrexate has been used as the mainstay therapy to prevent or ameliorate graft-versus-host disease (GVHD) in allogeneic bone marrow transplantation. We began a nonrandomized study in which methotrexate was not given routinely. Fifty-five patients underwent transplant for acute leukemia (44 patients), asplastic 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) years in the MTX+ group, and 16 (3-45) years in the MTX- group. Mean days (±SEM) to engraftment (neutrophils >500/μL, and platelets >20,000/μL untransfused) occurred earlier in the MTX- patients (19.6 2+ 1.4 v 24.9 ± 1.8 days for granulocytes, and 19.3 ± 1.5 27.4 ± 2.8 days for platelets, P < .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-I GVHD compared to 9/21 in the MTX- group). The interstitial pneumonitis occurred at a significantly increased rate in patients who received methotrexate (15/34) compared to those patients who did not (3/21) (P = .02). However, there was also a significant relationship between the interstitial pneumonitis and the preparative regimen: if the preparative regimen contained 1,000 rad single fraction total body irradiation, 8/14 patients were affected compared to 5/22 patients affected when 1,200 rad fractionated total body irradiation was used (P = .03). Because methotrexate significantly retards hematopoietic reconstitution, randomized trials for GVHD prevention are recommended.",
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N2 - Methotrexate has been used as the mainstay therapy to prevent or ameliorate graft-versus-host disease (GVHD) in allogeneic bone marrow transplantation. We began a nonrandomized study in which methotrexate was not given routinely. Fifty-five patients underwent transplant for acute leukemia (44 patients), asplastic 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) years in the MTX+ group, and 16 (3-45) years in the MTX- group. Mean days (±SEM) to engraftment (neutrophils >500/μL, and platelets >20,000/μL untransfused) occurred earlier in the MTX- patients (19.6 2+ 1.4 v 24.9 ± 1.8 days for granulocytes, and 19.3 ± 1.5 27.4 ± 2.8 days for platelets, P < .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-I GVHD compared to 9/21 in the MTX- group). The interstitial pneumonitis occurred at a significantly increased rate in patients who received methotrexate (15/34) compared to those patients who did not (3/21) (P = .02). However, there was also a significant relationship between the interstitial pneumonitis and the preparative regimen: if the preparative regimen contained 1,000 rad single fraction total body irradiation, 8/14 patients were affected compared to 5/22 patients affected when 1,200 rad fractionated total body irradiation was used (P = .03). Because methotrexate significantly retards hematopoietic reconstitution, randomized trials for GVHD prevention are recommended.

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