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Incidence of hypertension after marrow transplantation among 112 patients randomized to either cyclosporine or methotrexate as graft‐versus‐host disease prophylaxis
Author(s) -
Loughran T. P.,
Deeg H. J.,
Dahlberg S.,
Kennedy M. S.,
Storb R.,
Thomas E. D.
Publication year - 1985
Publication title -
british journal of haematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.907
H-Index - 186
eISSN - 1365-2141
pISSN - 0007-1048
DOI - 10.1111/j.1365-2141.1985.tb07342.x
Subject(s) - medicine , methotrexate , gastroenterology , cyclophosphamide , transplantation , incidence (geometry) , risk factor , graft versus host disease , cumulative incidence , surgery , relative risk , regimen , blood pressure , chemotherapy , confidence interval , physics , optics
S ummary We investigated the frequency of hypertension (sustained diastolic blood pressure ≥90 mmHg) in 112 patients given HLA‐identical marrow grafts. Patients were conditioned with 2 × 60 mg/kg of cyclophosphamide and 6 × 2 Gy of total body irradiation and randomized to receive as graft‐versus‐host disease prophylaxis either the standard methotrexate regimen ( n = 61) or cyclosporine ( n = 51), starting on day −1 as 12.5 mg/kg/d orally or as 3 mg/kg/d i.v. and later converting to p.o. when oral intake was tolerated. Kaplan‐Meier estimates indicate a 60% incidence of hypertension in the first 120 d in patients given cyclosporine (median time to onset: 4 d post transplant) compared to 20% in patients given methotrexate ( P <0.0001). Multifactorial analysis using a Cox regression model showed that cyclosporine was the most significant risk factor for developing hypertension (relative risk: 32.1, P <0.0001). In addition, glucocorticoids, used for treatment of GVHD, were associated with an increased risk for hypertension (relative risk 7.2, P <0.0001). Age, sex, underlying disease, cyclosporine trough levels, and renal function had no significant association with hypertension. Early therapy of hypertension in cyclosporine‐treated patients appears to be indicated.