A Randomized Study of the Prevention of Acute Graft-versus-Host Disease

TLDR

Acute graft‑versus‑host disease is a major problem in allogeneic bone‑marrow transplantation. The study compared two regimens for preventing acute graft‑versus‑host disease in allogeneic bone‑marrow transplantation. Thirty‑five patients received methotrexate alone, and 32 received methotrexate, antithymocyte globulin, and prednisone. The combination of methotrexate, antithymocyte globulin, and prednisone lowered acute graft‑versus‑host disease incidence from 48 % to 21 % (P = 0.01) and was associated with a higher risk in older patients (P = 0.001), supporting its use for prevention. N Engl J Med 1982; 306:392–7.

Abstract

Acute graft-versus-host disease is a major problem in allogeneic bone-marrow transplantation. We performed a randomized study to compare the effectiveness of two regimens in the prevention of acute graft-versus-host disease. Thirty-five patients received methotrexate alone, and 32 received methotrexate, antithymocyte globulin, and prednisone. Of the patients who received methotrexate alone, 48 per cent had acute graft-versus-host disease, as compared with 21 per cent of those who received methotrexate, antithymocyte globulin, and prednisone (P = 0.01). The age of the recipient was a significant factor in the development of acute graft-versus-host disease: Older patients had a higher incidence of the disease (P = 0.001). We conclude that the combination of methotrexate, antithymocyte globulin, and prednisone significantly decreased the incidence of acute graft-versus-host disease and should be used to prevent this disorder in patients receiving allogeneic marrow transplants. (N Engl J Med. 1982; 306:392–7.)