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

Norma K.C. Ramsay, John H. Kersey, Leslie L. Robison, Philip B. Mcglave, William G. Woods, William Krivit, Tae H. Kim, Anne I. Goldman, Mark E. Nesbit

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177 Scopus citations


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.), GRAFT-VERSUS-HOST disease continues to be a major cause of morbidity and mortality after allogeneic bone-marrow transplantation.1 Several methods have been used in attempts to prevent graft-versus-host disease, including methotrexate therapy after transplantation,1 in vitro treatment of the donor's marrow with anti-T-cell globulin2 or monoclonal antibody,3 and immunosuppression with cyclosporin4,5 or antithymocyte globulin6,7 after transplantation. Our report describes the results of a randomized trial comparing two prophylactic regimens designed to prevent acute graft-versus-host disease in patients receiving marrow transplants at the University of Minnesota. Specifically, the study compared the effectiveness of methotrexate alone with that of methotrexate in combination with antithymocyte.

Original languageEnglish (US)
Pages (from-to)392-397
Number of pages6
JournalNew England Journal of Medicine
Issue number7
StatePublished - Feb 18 1982

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