Impact on relapse of corticosteroid therapy after allogeneic hematopoietic stem cell transplantation for acute myeloid leukemia

Abstract

Corticosteroids are often used following allogeneic hematopoietic stem cell transplantation (HSCT) to control complications such as graft-versus-host disease (GVHD). However, there is some concern that corticosteroids may suppress the graft-versus-leukemia effect and increase leukemia relapse. To evaluate the effect of corticosteroids on relapse, we analyzed 112 adult patients who received their first allogeneic HSCT for acute myeloid leukemia at our institution between 1997 and 2007. Fifty-seven patients (50.9%) received corticosteroid therapy. Patients who had corticosteroid therapy included higher proportion of patients who developed GVHD. In multivariate analysis, with corticosteroid administration entered as a time-dependent covariate, corticosteroid administration was not a risk factor for relapse (p = 1.00, hazard ratio [HR] 1.00, 95% confidence interval [CI] 0.53-1.88), but it was associated with higher non-relapse mortality (NRM) (p < 0.001, HR 55.5, 95% CI 7.42-416) and lower overall survival (p < 0.001, HR 2.68, 95% CI 1.56-4.61). The higher NRM associated with corticosteroid administration was mainly due to the increased deaths caused by the complications themselves, which required corticosteroid therapy. The findings of this study indicate the importance of controlling complications after allogeneic HSCT. The strategy of refraining from indispensable corticosteroid therapy because of the excessive concerns about relapse should be avoided.