Long-term outcomes of corticosteroid graft versus host disease prophylaxis in peripheral blood allogeneic haemopoietic stem cell transplant: a comparative cohort analysis

BackgroundCorticosteroids (CSs) have previously been incorporated into graft versus host disease (GVHD) prophylaxis regimens for bone marrow (BM) and haemopoietic stem cell transplant (HSCT). AimsTo assess the impact of prophylactic CS in HSCT using peripheral blood (PB) stem cells. MethodsPatients were identified from three HSCT centres receiving a first PB-HSCT between January 2011 and December 2015 from a fully human leukocyte antigen (HLA)-matched sibling or unrelated donor for acute myeloid leukaemia or acute lymphoblastic leukaemia. To enable meaningful comparison, patients were divided into two cohorts. ResultsCohort 1 included only myeloablative-matched sibling HSCT, where the only variation in GVHD prophylaxis was the addition of CS. In these 48 patients, there were no differences in GVHD, relapse, non-relapse mortality, overall survival or GVHD-relapse-free-survival (GRFS) at 4 years after transplant. Cohort 2 included the remaining HSCT recipients, where one group received CS-prophylaxis and the non-CS group received an antimetabolite, ciclosporin and anti-T-lymphocyte globulin. In these 147 patients, those receiving CS-prophylaxis experienced higher rates of chronic GVHD (71% vs 18.1%, P < 0.001) and lower rates of relapse (14.9% vs 33.9%, P = 0.02). Those receiving CS-prophylaxis had a lower 4-year GRFS (15.7% vs 40.3%, P = 0.002). ConclusionsThere does not appear to be a role for adding CS to standard GVHD prophylaxis regimens in PB-HSCT.

Automated summary

This study assessed the impact of prophylactic corticosteroids in peripheral blood stem cell transplantation (PB-HSCT). The results showed that adding corticosteroids did not affect the occurrence of GVHD, relapse, or overall survival in matched sibling HSCT. However, in other recipients, those receiving corticosteroids had higher rates of chronic GVHD, lower relapse rates, and lower GVHD-relapse-free survival. Therefore, adding corticosteroids to standard GVHD prophylaxis regimens in PB-HSCT does not appear to be necessary.