Where is the start line?

摘要

In this issue ofBlood, Mielcarek and colleagues report on the results of a retrospective analysis of the outcomes of initial acute GVHD therapy.Despite advances in the management of complications related to hematopoietic cell transplantation, treatment of acute graft-versus-host disease (GVHD) remains subopti-mal. Corticosteroids are the primary front-line therapy for acute GVHD at a standard dose of 2 mg/kg per day prednisone, with response rates of about 50%.1_3 In this issue ofBlood, Mielcarek et al report on the outcomes of initial acute GVHD therapy among 773 transplantation patients at the Fred Hutchinson Cancer Research Center from 2000 to 2005.4Patients were treated with either the standard dose of 2 mg/kg per day prednisone or low-dose prednisone (1 mg/kg per day) at the discretion of the attending physician. By day 100 after initiating therapy, patients treated in the low-dose group received a mean cumulative dose of 44 mg/kg compared with 87 mg/kg in the standard-dose group. Adjusted outcomes between the 2 groups were not statistically different. In multivariate analysis, treatment with low-dose steroids was associated with a reduction in prolonged hospitalization and atrend toward lower risk for invasive fungal infections. The authors conclude that initial treatment with low-dose prednisone did not compromise acute GVHD control or mortality and was associated with decreased toxicity.