INFLUENCE OF FOLINIC ACID RESCUE ON METHOTREXATE-RELATED TOXICITY ANDGRAFT-VERSUS-HOST DISEASE AFTER ALLOGENEIC BONE-MARROW TRANSPLANTATION

40 consecutive patients receiving allogeneic bone marrow transplantati on (BMT) from HLA-identical sibling donors were randomized to receive cyclosporin A and methotrexate (MTX) +/- folinic acid rescue (FAR) as graft-versus-host disease (GVHD) prophylaxis. Eleven out of 20 patient s in the FAR group have completed all methotrexate doses versus no pat ients out of 20 in the control group. In the FAR group 13 patients are alive and disease free versus 8 patients in the control group (p < 0. 05). Compared with the control group, patients receiving FAR had a low er incidence of grade II-IV stomatitis (p = 0.01), shorter periods of total parenteral nutrition (p = 0.0001), and less hepatic regimen rela ted toxicity (p = 0.026). The difference between the overall incidence and severity of GVHD in both groups was statistically nonsignificant. We conclude that FAR reduces regimen related toxicity in patients rec eiving cyclosporin A/MTX acute GVHD prophylaxis without significantly influencing GVHD incidence or severity and may even lead to a benefici al effect on disease free survival.