Graft‐versus‐host disease prophylaxis with anti‐T‐cell monoclonal antibody OKT3, prednisone and methotrexate in allogeneic bone‐marrow transplantation

A. H. Filipovich, C. L. Krawczak, J. H. Kersey, P. McGlave, N. K.C. Ramsay, A. Goldman, G. Goldstein

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25 Scopus citations

Abstract

A new regimen for prevention of acute graft‐versus‐host disease (GvHD)—OKT3 (murine monoclonal anti‐pan‐T antibody), prednisone and methotrexate (OKT3‐pred‐MTX)—was compared with the Minnesota standard regimen—antithymocyte globulin, prednisone and methotrexate (ATG‐pred‐MTX)—for adverse effects, effect on incidence of acute GvHD, and survival at 1 year post‐transplant. Twenty patients (aged 25 ± 9 years) had bone‐marrow transplantation (BMT) from their HLA‐MLC identical sibling donors for treatment of aplastic anaemia (four), acute leukaemia in remission (13) or chronic myelogenous leukaemia (three). These 20 patients received (OKT3‐pred‐MTX) on days 8‐22 post‐transplant. Results of this group are compared to those of 19 concurrent patients (aged 26 ± 12 years) who received ATG‐pred‐MTX on days 8‐22 post‐transplant. On the first day of treatment, 20/20 OKT3 patients and 18/19 ATG patients were febrile, Within 24 h of the first dose of OKT3, 6/20 patients experienced dyspnoea or chest pain and 3/20 patients developed diarrhoea. No further adverse effects were seen after the second dose of OKT3 and no late adverse effects were attributed to this drug. Time to engraftment (x̄ 25 d) was not statistically significantly different in the two prophylactic groups. Acute GvHD was diagnosed in 14 of 20 patients who received OKT3‐pred‐MTX and in eight of 19 patients who received ATG‐pred‐MTX (P= 0.06). The incidence of hepatic or gastrointestinal GVHD (≥ grade 2) was similar in the two groups: 4/20 OKT3‐pred‐MTX, 6/19 ATG‐pred‐MTX. Characteristics of post‐transplant infections were also similar for the two prophylactic groups. Survival at 1 year post‐transplant was 65% for patients

Original languageEnglish (US)
Pages (from-to)143-152
Number of pages10
JournalBritish journal of haematology
Volume60
Issue number1
DOIs
StatePublished - May 1985

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