Effect of graft versus host disease prophylaxis on the leukemia free survival in pediatric patients who hematopoetic stem cell transplanted for leukemia

Hematopoietic stem cell transplantation (HSCT) is an important treatment modality for leukemia, the most common childhood malignancy. Graft versus host disease, one of the most important complication of transplantation, is the most important cause of morbidity and mortality. In our study, we aimed to show the effect of methotrexate doses given in transplants due to leukemia, the development of acute or chronic GVHD, on leukemia-free survival. Patients who underwent HSCT due to leukemia, between April 2010-October 2020 at a pediatric transplantation unit were included in the study. Methotrexate doses given to patients; were grouped as 10mg/m2 on day 1,3,6; 10mg/m2 on day 1,3, 5mg/m2 on day 6; 10mg/m2 on day 1, 3; 10mg/m2 on day 1 and 5 mg/m2 on day 3,6; 10 mg/m2 on day 1 and also 5 mg/m2 on day 1. The effects of these groups on event-free and overall survival were evaluated. Recurrence was not observed in 72 of 93 patients evaluated in the ALL group (77.4%). The conditioning regimens were considered TBI-Busulfan-based regimens. No significant difference was observed in terms of LFS. The absence of aGVHD in the ALL patient group significantly prolongs LFS, when evaluated according to CR1-2-3 groups, CR2 significantly extended the LFS time. Effect of GVHD prophylaxis on LFS was evaluated no significant effect of methotrexate dose on LFS was observed. The most important factor affecting leukemia-free survival is the state of remission. The longest duration of LFS was detected in CR1. The effect of methotrexate dose as GVHD prophylaxis has not been determined. There was no consensus in the studies on methotrexate doses in the literature. It is necessary to study with a larger cohort.