Is there any role for corticosteroids in GvHD prophylaxis?

Summary Corticosteroids have an established role as the fi rst-line treatment of graft -versus-host disease (GvHD), but their role in the prophylaxis of GvHD is less clear. At present, corticosteroids are included in the prophylaxis regimens only rarely. Studies of adding corticosteroid to the most widely used prophylactic regimen, cyclosporine A and a short course of methotrexate, have yielded confl icting results, possibly due to diff erences in the treatment schedule. In our earlier published randomized prospective study, the addition of methylprednisolone (MP) to cyclosporine and methotrexate resulted in a markedly reduced incidence of acute GvHD. No diff erence was seen in the survival. In long-term follow-up of this study, aft er a median follow-up of 24.5 years in living patients, we observed a marked late non-relapse mortality among the patients not given prophylactic MP, probably due to higher incidence of chronic GvHD in this study arm. At the end of the follow-up, 55% of the patients given MP in the prophylaxis were alive, compared with 20% in the control arm. Th ese fi ndings suggest that the role of corticosteroids in GvHD prophylaxis should be reevaluated.