• Stéphane Vigouroux, Reza Tabrizi, Cyril Melot, Joelle Coiffard, Xavier Lafarge, Gérald Marit, Krimo Bouabdallah, Arnaud Pigneux, Thibaut Leguay, Marie-Sarah Dilhuydy, Anna Schmitt, Jean-Michel Boiron, and Noël Milpied.
• Service des Maladies du Sang, CHU Haut-Lévêque, Bordeaux, France.
• Biol. Blood Marrow Transplant. 2011 Jan 1; 17 (1): 93-100.

AbstractOptimized prophylaxis against graft-versus-host disease (GVHD) after unrelated reduced-intensity allogeneic transplantation when preceded by a conditioning regimen utilizing antithymocyte globulin (ATG) is poorly defined. To investigate the effects of methotrexate (MTX) in this treatment setting, we conducted a retrospective analysis. Sixty-three patients were selected based on the administration of a total dose of 5 mg/kg of ATG in the conditioning regimen and then separated into either group M+ (n = 39), which received MTX or group M- (n = 24), which did not. All patients received cyclosporine. In the M- and M+ groups, cumulative incidences (CI) of grade III-IV acute GVHD (aGVHD) were 43% and 10%, respectively (P = .002). Multivariate analysis indicated that grade III-IV aGVHD was favored by both the absence of MTX and the provision of a female donor for a male recipient. At 2 years, the M+ and M- groups exhibited, respectively: overall survival of 69% and 40% (P = .06), disease-free survival of 57% and 43% (P = .2), nonrelapse mortality of 20% and 44% (P = .1), and incidence of relapse of 27% and 35% (P = .6). These data suggest that MTX reduces the incidence of severe aGVHD without increasing the risk of relapse but with an accompanying trend toward improved survival after unrelated reduced-intensity transplantation with ATG in the conditioning regimen.2011 American Society for Blood and Marrow Transplantation. Published by Elsevier Inc. All rights reserved.

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