Prophylaxis of graft-versus-host disease with cyclosporine-prednisone is associated with increased risk of chronic graft-versus-host disease

To determine the effect of two different graft-versus-host disease (GVHD) p rophylactic regimens - cyclosporine with short course of methotrexate (CYA- MTX) and cyclosporine with prednisone (CYA-PRED) - on the incidence of chro nic GVHD (cGVHD), we retrospectively reviewed the outcomes of 196 consecuti ve allogeneic related blood and marrow transplants performed at our institu tion utilizing one of these regimens. CYA-PRED was given to patients who we re transplanted more recently because of concern about the increased risk o f veno-occlusive disease of the liver, increased mucositis, and slower engr aftment in patients receiving CYA-MTX. Prophylaxis with CYA-PRED was associ ated with a higher risk of development of cGVHD (risk ratio (RR) 3.5; 95% c onfidence intrerval (CI), 2.2-5.4), The proportion of patients with extensi ve disease among those developing cGVHD was higher in the CYA-PRED group (7 1%) than in the CYA-MTX group (57%), although this difference was not stati stically significant. The cumulative probability of extensive cGVHD at 2 ye ars was higher in the CYA-PRED group (RR 4.2, 95% CI, 2.4-7.4), Development of acute GVHD and cytomegalovirus mismatch were independent predictors of increased risk of cGVHD, We conclude that GVHD prophylaxis with CYA-PRED is associated with higher overall rate of cGVHD compared to CYA-MTX. The type of GVHD prophylaxis should be considered when comparing the incidence of c GVHD reported in different studies.