1986 Volume 27 Issue 1 Pages 30-35
We have used a combination prophylactic protocol to prevent acute graft-versus-host disease (GVHD) for six patients underwent allogeneic bone marrow transplantation (BMT). The protocol, designated as HDMP protocol, consists of high dose methylprednisolone (500 mg/body) immediately before the infusion of marrow graft, followed by prednisolone (40 mg/m2, Day 1∼7) and methotrexate with the dose of 5 mg/m2 on Day 1, 3, 6 and thereafter 10 mg/m2 weekly. We evaluated the availability of this protocol by comparing to the standard protocol using methotrexate (MTX protocol) which were given to seven patients.
Acute GVHD occurred in three of seven patients using MTX protocol (Grade I: two, Grade IV: one) as compared to all of six patients using HDMP protocol (Grade I: two, Grade II: two, Grade III: two).
Severe acute GVHD (Grade III or IV) was seen in the patients older than 30 y., suggesting that the age of the patients may be one of the factors affecting the outcome of GVHD as described by others. As for the hematological recovery duration, there was no statistical difference between both groups of the protocol. The mean days of febril episodes following BMT were 17 days per a case for the group of MTX protocol, whereas only two days were observed in all cases using HDMP protocol. Also, no patient was complicated with oral mucositis in the group of HDMP protocol. However, all but one patient with aplastic anemia suffered from troublesome mucositis in the group of MTX protocol.
In conclusion, HDMP protocol appeared to be not so excellent as the MTX protocol from the aspect of prophylaxis against GVHD, however, it may be better with respect to the easy management of the early complications such as fever and mucositis.
At present, satisfactory GVHD prophylaxis has not be established yet. More effective regimen should be developed hopefully soon in order to prevent severe GVHD following allogenetic BMT.
