Graft versus host disease (GVHD) prophylaxis

GVHD is a serious complication of transplanting stem cells from a donor into a patient. These cells can attack the host. Calcineurin inhibitors, such as cyclosporine and tacrolimus,  are commonly used in the prophylaxis of GvHD. 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.

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