A three or more drug combination as effective therapy for moderate or severe chronic graft-versus-host disease

We analyzed the results of a three or more drug combination as treatment fo r moderate or severe cGVHD developing after transplantation for thalassemia , in 45 patients with median age of 11 (range 2-26) years. Eighteen patient s received a three drug regimen with cyclosporine (CsA), methylprednisolone (MP) and azathioprine (AZ) as first line therapy, 16 patients received thi s regimen as salvage therapy and 11 patients were given a four or five drug regimen with CsA, MP, AZ, cyclophosphamide (CY) and/or methotrexate (MTX) mainly as salvage therapy. The overall complete response (CR) rate was 77.3 %, with 94% of CR in patients receiving the three drug regimen as first lin e, 88% in patients receiving it as salvage therapy and 36.6% in patients gi ven the four or five drug regimen. The probability of CR in patients given the three drug regimen as first or salvage therapy or the four/five drug re gimen was 89%, 53% and 30%, while the probability of survival was 89%, 65% and 58%, respectively. The incidence of treatment failure was low in our pa tients. Patients treated with the three drug regimen as first line therapy had less treatment-related complications than patients receiving this regim en as salvage therapy or patients given the four or five drug regimen. The main causes of treatment-related mortality (20%) were infectious complicati ons. This retrospective study showed that a three or more drug combination is safe and effective for treatment of moderate or severe cGVHD at least in younger patients.