In a nutshell
This study looked at the effects of using steroid medication to prevent complications after stem cell transplant and improve survival in patients with leukemia. Researchers found that low-dose steroids improved outcomes in these patients.
Leukemia is a cancer of the blood-forming tissues such as the bone marrow and lymphatic system. It is often treated with medication that destroys the abnormal cells. The cells can then be replaced with healthy stem cells from a donor. This is called an allogeneic stem cell transplant (alloSCT).
One complication of this treatment is graft versus host disease (GVHD). It means that the newly transplanted cells start attacking the patient's body. In some cases, this complication can become life-threatening. Steroids, such as methylprednisolone (MP; Medrol), are medications that can reduce the immune response. They have been shown to help with this complication. However, in high doses, they can also increase the risk of infections and other side effects such as damage to the hip bone. Whether a low-dose of steroids in patients at high-risk of GVHD can reduce the risk of this complication and improve survival in patients with leukemia remains under investigation.
Methods & findings
228 patients who received an alloSCT were included in the study. Patients were put into 3 groups. Group A had 83 low-risk patients. Group B had 72 high-risk patients who received steroid treatment (MP). Group C had 73 high-risk patients who did not receive steroid treatment. Patients were followed up for an average of 1659 days.
The overall survival for all patients was 73%. 60% of all patients developed GVHD over time. At 5 years, group B had a lower overall rate (both mild and severe) of GVHD (46%) compared to group C (65%) and to group A (67%).
The three groups had a similar risk of infections after 100 days after alloSCT. Group B had a lower risk of herpes zoster infection (12%) compared to group C (28%), but similar to group A (15%). Damage to the hip bone was also lower in patients in group B (6%) compared to group C (16%), but similar to group A (7%).
The bottom line
The study concluded that low-dose steroids were effective in the prevention of complications from donor stem cell transplant.
The fine print
This study had a small sample size. Larger studies may be needed to confirm results.
Published By :
Biology of blood and marrow transplantation: journal of the American Society for Blood and Marrow Transplantation
Dec 18, 2018