Comparative Analysis of Calcineurin Inhibitor-Based Methotrexate and Mycophenolate Mofetil-Containing Regimens for Prevention of Graft-versus-Host Disease after Reduced-Intensity Conditioning Allogeneic Transplantation.
Adult
Aged
Allografts
Calcineurin Inhibitors
/ administration & dosage
Disease-Free Survival
Female
Graft vs Host Disease
/ mortality
Hematopoietic Stem Cell Transplantation
Humans
Leukemia
/ mortality
Male
Methotrexate
/ administration & dosage
Middle Aged
Mycophenolic Acid
/ administration & dosage
Myelodysplastic Syndromes
/ mortality
Retrospective Studies
Siblings
Survival Rate
Tacrolimus
/ administration & dosage
Transplantation Conditioning
Allogeneic hematopoietic cell transplantation
Calcineurin inhibitor Tacrolimus
Cyclosporine
Graft-versus-host disease prophylaxis
Methotrexate
Mycophenolate mofetil
Reduced-intensity conditioning
Journal
Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation
ISSN: 1523-6536
Titre abrégé: Biol Blood Marrow Transplant
Pays: United States
ID NLM: 9600628
Informations de publication
Date de publication:
01 2019
01 2019
Historique:
received:
07
06
2018
accepted:
09
08
2018
pubmed:
29
8
2018
medline:
24
12
2019
entrez:
29
8
2018
Statut:
ppublish
Résumé
The combination of a calcineurin inhibitor (CNI) such as tacrolimus (TAC) or cyclosporine (CYSP) with methotrexate (MTX) or with mycophenolate mofetil (MMF) has been commonly used for graft-versus-host disease (GVHD) prophylaxis after reduced-intensity conditioning (RIC) allogeneic hematopoietic cell transplantation (alloHCT), but there are limited data comparing efficacy of the 2 regimens. We evaluated 1564 adult patients who underwent RIC alloHCT for acute myelogenous leukemia (AML) and acute lymphoblastic leukemia (ALL), chronic myelogenous leukemia (CML), and myelodysplastic syndrome (MDS) from 2000 to 2013 using HLA-identical sibling (matched related donor [MRD]) or unrelated donor (URD) peripheral blood graft and received CYSP or TAC with MTX or MMF for GVHD prophylaxis. Primary outcomes of the study were acute and chronic GVHD and overall survival (OS). The study divided the patient population into 4 cohorts based on regimen: MMF-TAC, MMF-CYSP, MTX-TAC, and MTX-CYSP. In the URD group, MMF-CYSP was associated with increased risk of grade II to IV acute GVHD (relative risk [RR], 1.78; P < .001) and grade III to IV acute GVHD (RR, 1.93; P = .006) compared with MTX-TAC. In the URD group, use of MMF-TAC (versus MTX-TAC) lead to higher nonrelapse mortality. (hazard ratio, 1.48; P = .008). In either group, no there was no difference in chronic GVHD, disease-free survival, and OS among the GVHD prophylaxis regimens. For RIC alloHCT using MRD, there are no differences in outcomes based on GVHD prophylaxis. However, with URD RIC alloHCT, MMF-CYSP was inferior to MTX-based regimens for acute GVHD prevention, but all the regimens were equivalent in terms of chronic GVHD and OS. Prospective studies, targeting URD recipients are needed to confirm these results.
Identifiants
pubmed: 30153491
pii: S1083-8791(18)30489-0
doi: 10.1016/j.bbmt.2018.08.018
pmc: PMC6355336
mid: NIHMS1509330
pii:
doi:
Substances chimiques
Calcineurin Inhibitors
0
Mycophenolic Acid
HU9DX48N0T
Tacrolimus
WM0HAQ4WNM
Methotrexate
YL5FZ2Y5U1
Types de publication
Clinical Trial
Comparative Study
Journal Article
Multicenter Study
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
73-85Subventions
Organisme : NCATS NIH HHS
ID : KL2 TR002381
Pays : United States
Organisme : NCI NIH HHS
ID : P30 CA077598
Pays : United States
Organisme : NCI NIH HHS
ID : U24 CA076518
Pays : United States
Organisme : NCATS NIH HHS
ID : UL1 TR002378
Pays : United States
Informations de copyright
Copyright © 2018 American Society for Blood and Marrow Transplantation. Published by Elsevier Inc. All rights reserved.
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