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Annals of Hematology
Erschienen in: Annals of Hematology 4/2014

01.04.2014 | Original Article

Safety and efficacy of low-dose methotrexate for pediatric patients with steroid-refractory acute graft-versus-host disease after hematopoietic stem cell transplantation

verfasst von: Jiro Inagaki, Reiji Fukano, Yuichi Kodama, Miho Nishimura, Mototsugu Shimokawa, Jun Okamura

Erschienen in: Annals of Hematology | Ausgabe 4/2014

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Abstract

Low-dose methotrexate (LD-MTX) has long been included in prophylaxis regimens for acute graft-versus-host disease (aGVHD). In addition, LD-MTX is expected as a treatment option to control aGVHD by regulating the cytokine network. In this study, we retrospectively evaluated 35 patients with steroid-refractory acute GVHD to evaluate the safety and efficacy of LD-MTX as a salvage treatment. LD-MTX was administered weekly at a dose of 10 mg/m2. Overall, 13 patients (37 %) achieved complete response and three (9 %) achieved partial response within 4 weeks after LD-MTX was initiated without any additional agents. Resolution of manifestations of aGVHD in each evaluable organ was observed in 12 of the 23 cases (52 %) with skin aGVHD and in eight of the 23 cases (35 %) with GI aGVHD. Neutropenia and thrombocytopenia (grades III and IV) were observed in nine (26 %) and 17 patients (49 %), respectively. Fatal infectious complications occurred in only three patients (9 %) after LD-MTX treatment. Of the 35 patients studied, 22 were alive with a median follow-up of 60 months and an overall survival rate (Kaplan–Meier estimate) was 62 %. LD-MTX seems suitable for salvage therapy and will not increase risk of infection. Further evaluation of the use of LD-MTX as salvage therapy for steroid-refractory acute GVHD is warranted.
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Metadaten
Titel
Safety and efficacy of low-dose methotrexate for pediatric patients with steroid-refractory acute graft-versus-host disease after hematopoietic stem cell transplantation
verfasst von
Jiro Inagaki
Reiji Fukano
Yuichi Kodama
Miho Nishimura
Mototsugu Shimokawa
Jun Okamura
Publikationsdatum
01.04.2014
Verlag
Springer Berlin Heidelberg
Erschienen in
Annals of Hematology / Ausgabe 4/2014
Print ISSN: 0939-5555
Elektronische ISSN: 1432-0584
DOI
https://doi.org/10.1007/s00277-013-1923-x

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