Calcineurin inhibitors, such as cyclosporine and tacrolimus, are commonly used in the prophylaxis of GvHD (BCH guideline). For full-intensity stem cell transplantation most centres use a combination of a calcineurin inhibitor, such as ciclosporin or tacrolimus, given in combination with methotrexate. Low-dose methotrexate was the first generally prescribed GVHD preventive regimen for use as a cell-cycle specific chemotherapeutic agent following transplant and was subsequently combined with a T cell activation inhibitor, such as cyclosporin and tacrolimus. Calcineurin inhibitor-based regimens are now the most common form of GVHD prophylaxis. The majority of clinical trials over the past decades have shown the superiority of combination of a calcineurin inhibitor and a short course of methotrexate over either agent alone in the reduction of GVHD incidence and improvement in survival. A meta-analysis of prophylaxis regimens for GVHD also supports the use of cyclosporin-methotrexate over cyclosporin alone.
Bhurani D, Schifter M, Kerridge I. Folinic acid administration following MTX as prophylaxis for GVHD in allogeneic HSCT centres in Australia and New Zealand.Bone Marrow Transplant. 2008 Oct;42(8):547-50.
Ross M, Schmidt GM, Niland JC, et al. Cyclosporine, methotrexate, and prednisone compared with cyclosporine and prednisone for prevention of acute graft-vs.-host disease: Effect on chronic graft-vs.-host disease and long-term survival. Biol Blood Marrow Transplant. 1999;5:285-291.
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