OMISSION OF DAY 11 METHOTREXATE DOES NOT APPEAR TO INFLUENCE THE INCIDENCE OF MODERATE TO SEVERE ACUTE GRAFT-VERSUS-HOST DISEASE, CHRONIC GRAFT-VERSUS-HOST DISEASE, RELAPSE RATE OR SURVIVAL AFTER HLA-IDENTICALSIBLING BONE-MARROW TRANSPLANTATION

Sixty-five patients with haematological malignancy received high-dose chemotherapy or chemoradiotherapy followed by a T replete, HLA-identic al sibling bone marrow transplant. All were scheduled to receive a sta ndard cyclosporine/methotrexate immune suppressive regimen to minimise the risk of graft-versus-host disease post-transplant. Forty-six pati ents received all four scheduled doses of methotrexate, while in ninet een the day 11 dose was omitted due to marked oropharyngeal mucositis or febrile neutropenia. There was a slight increase in the incidence o f acute graft-versus-host disease (GVHD) grades I-IV in those not rece iving compared to those receiving day 11 methotrexate (84 vs 71% (P = 0.04)). However, there was no difference in the incidence of acute GVH D grades II-IV (14 vs 22%), in the incidence of chronic GVHD (38 vs 47 %), in transplant-related mortality (21 vs 24%), in relapse rate (42 v s 51%), in 4-year survival (38 vs 48%), or in disease-free survival (3 8 vs 42%). These findings suggest that the day 11 methotrexate dose co uld be omitted without a major deleterious effect on the outcome of HL A-identical sibling marrow transplantation.