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KMID : 1130320130560110490
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Korean Journal of Pediatrics
2013 Volume.56 No. 11 p.490 ~ p.495
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Evaluation of risk for graft-versus-host disease in children who receive less than the full doses of mini-dose methotrexate for graft-versus-host disease prophylaxis in allogeneic hematopoietic stem cell transplantation
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Yum Sook-Kyung
Choi Hye-Yoon
Lee Jae-Wook
Jang Pil-Sang
Chung Nack-Gyun
Jung Dae-Chul
Cho Bin
Kim Hack-Ki
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Abstract
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Purpose: The use of cyclosporine and mini-dose methotrexate (MTX) is a common strategy for graftversus-
host disease (GVHD) prophylaxis in allogeneic transplants. We investigated whether patients
who receive fewer than the planned MTX doses are at increased risk for GVHD.
Methods: The study cohort included 103 patients who received allogeneic transplants at the
Department of Pediatrics of The Catholic University of Korea College of Medicine, from January 2010
to December 2011. MTX was administered on days 1, 3, 6, and 11 after transplant at a dose of 5 mg/
m2 each. Within the cohort, 76 patients (74%) received all 4 doses of MTX [MTX(4) group], while 27
patients (26%) received 0?3 doses [MTX(0?3) group].
Results: Although there was no difference in neutrophil engraftment between the 2 groups, platelet
engraftment was significantly faster in the MTX(4) group (median, 15 days), compared to the MTX(0?
3) group (median, 25 days; P =0.034). The incidence of grades II?IV acute GVHD was not different
between the MTX(4) and MTX(0?3) groups (P =0.417). In the multivariate study, human leukocyte
antigen mismatch was the most significant factor causing grades II?IV acute GVHD (P =0.002),
followed by female donor to male recipient transplant (P =0.034). No difference was found between the
MTX(4) and MTX (0?3) groups regarding grades III?IV acute GVHD, chronic GVHD, and disease-free
survival.
Conclusions: Our results indicate that deviations from the full dose schedule of MTX for GVHD
prophylaxis do not lead to increased incidence of either acute or chronic GVHD.
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KEYWORD
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Methotrexate , Graft-versus-host disease , Prophylaxis
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