TREATMENT OF MODERATE TO SEVERE ACUTE GRAFT-VERSUS-HOST DISEASE - A RETROSPECTIVE ANALYSIS

Seventy-one patients with moderate to severe acute GVHD after BMT were analysed retrospectively, At the start of therapy 96% of the patients had rashes, 45% liver abnormalities and 54% gut dysfunctions. Forty-f our patients (62%) had been treated for grade I GVHD with systemic cor ticosteroids. First therapy for moderate to severe acute GVHD was with corticosteroids (n = 59), psoralen with ultraviolet light (PUVA) (n = 14), cyclosporin (CsA) (n = 10), antithymocyte globulin (ATG) (n = 7) , methotrexate (MTX) (n = 2), monoclonal antibodies (n = 1) or thalido mide (n = 1). In 18 of these patients two or more agents were combined . Resolution of skin disease and evaluable liver and gut disease were seen in 48%, 44% and 47% of cases, respectively. Overall complete reso lution was seen in 37%. Thirty-two patients received a second treatmen t, resulting in complete resolution in 31%. Patients with a complete r esponse had an actuarial transplant-related mortality of 37% compared with 82% or worse for patients with other outcomes (p less than or equ al to 0.003). Combined treatment was superior to ATG, but not better t han corticosteroids. In multivariate analysis a low total sum severity score was the only factor associated with complete response (p = 0.02 ). AML diagnosis (p = 0.01) and GVHD of the liver (p = 0.02) were inde pendent risk factors for treatment failure.