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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

  • Original Article – Clinical Oncology
  • Published:
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Abstract

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.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical standard

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008. Informed consent was obtained from all patients for being included in the study.

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Authors and Affiliations

  1. Department of Pediatrics, Jena University Hospital, Kochstrasse 2, 07740, Jena, Germany

    Melissa Weiss, Felix Zintl, James Beck & Bernd Gruhn

  2. Department of Pediatrics, Ulm University Hospital, Eythstrasse 24, 89075, Ulm, Germany

    Daniel Steinbach

Authors
  1. Melissa Weiss
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  2. Daniel Steinbach
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  3. Felix Zintl
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  4. James Beck
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  5. Bernd Gruhn
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Correspondence to Bernd Gruhn.

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Weiss, M., Steinbach, D., Zintl, F. et al. 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. J Cancer Res Clin Oncol 141, 1089–1094 (2015). https://doi.org/10.1007/s00432-014-1885-y

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  • DOI: https://doi.org/10.1007/s00432-014-1885-y

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