Liesveld J, Duerst R, Rapoport A, Constine L, Abboud C, Packman C, Wedow L, Zwetsch L, McKenna B, Linder T, Silverman W, Swift S, Rowe J, DiPersio J
Department of Medicine, University of Rochester School of Medicine, Rochester, NY 14642, USA.
Bone Marrow Transplant. 1999 Sep;24(5):511-6. doi: 10.1038/sj.bmt.1701947.
Unrelated donor marrow transplantation is associated with an increased incidence of graft-versus-host disease (GVHD) compared with sibling donor transplants. Forty-one patients undergoing unrelated donor transplants were treated with a GVHD prophylaxis regimen that consisted of continuous infusion cyclosporine from day -1 to 100 days post transplant along with nifedipine, glucocorticoids and short-course methotrexate. The regimen was well-tolerated in this cohort with mostly high risk disease. Fifty-one percent of patients developed acute GVHD, which was grade III-IV in 22% of patients. Six of 22 patients at risk for chronic GVHD developed extensive chronic GVHD, five of whom were adults. In patients <18 years of age, there was a >40% chance of 2 year disease-free survival. Use of continuous infusion cyclosporine with nifedipine as an immunosuppressant and protectant against cyclosporine-induced toxicities in unrelated donor transplants is well-tolerated, and results in acute GVHD incidence favorable to that reported with bolus cyclosporine.