• Richard Blennerhassett, Jad Othman, Amber Biscoe, David Kliman, Georgia Mills, Emily Blyth, Kenneth Micklethwaite, John Kwan, Ian Bilmon, Abir Bhattacharyya, Shyam Panicker, Keith Fay, Sam Milliken, David Ma, Nada Hamad, William Stevenson, Chris Arthur, John Moore, Matthew Greenwood, David Gottlieb, and Ian Kerridge.
• Department of Haematology, St Vincent's Hospital, Sydney, New South Wales, Australia.
• Intern Med J. 2023 Nov 1; 53 (11): 197919861979-1986.

BackgroundCorticosteroids (CSs) have previously been incorporated into graft versus host disease (GVHD) prophylaxis regimens for bone marrow (BM) and haemopoietic stem cell transplant (HSCT).AimsTo assess the impact of prophylactic CS in HSCT using peripheral blood (PB) stem cells.MethodsPatients were identified from three HSCT centres receiving a first PB-HSCT between January 2011 and December 2015 from a fully human leukocyte antigen (HLA)-matched sibling or unrelated donor for acute myeloid leukaemia or acute lymphoblastic leukaemia. To enable meaningful comparison, patients were divided into two cohorts.ResultsCohort 1 included only myeloablative-matched sibling HSCT, where the only variation in GVHD prophylaxis was the addition of CS. In these 48 patients, there were no differences in GVHD, relapse, non-relapse mortality, overall survival or GVHD-relapse-free-survival (GRFS) at 4 years after transplant. Cohort 2 included the remaining HSCT recipients, where one group received CS-prophylaxis and the non-CS group received an antimetabolite, ciclosporin and anti-T-lymphocyte globulin. In these 147 patients, those receiving CS-prophylaxis experienced higher rates of chronic GVHD (71% vs 18.1%, P < 0.001) and lower rates of relapse (14.9% vs 33.9%, P = 0.02). Those receiving CS-prophylaxis had a lower 4-year GRFS (15.7% vs 40.3%, P = 0.002).ConclusionsThere does not appear to be a role for adding CS to standard GVHD prophylaxis regimens in PB-HSCT.© 2023 The Authors. Internal Medicine Journal published by John Wiley & Sons Australia, Ltd on behalf of Royal Australasian College of Physicians.

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