Inferior Outcomes with Cyclosporine and Mycophenolate Mofetil after Myeloablative Allogeneic Hematopoietic Cell Transplantation.

Adolescent Adult Aged Allografts Cyclosporine / administration & dosage Disease-Free Survival Female Graft vs Host Disease / mortality Hematopoietic Stem Cell Transplantation Humans Male Middle Aged Mycophenolic Acid / administration & dosage Survival Rate
Allogeneic hematopoietic cell transplantation Graft-versus-host disease Methotrexate Mycophenolate mofetil Myeloablative

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:
09 2019
Historique:
received: 03 04 2019
revised: 15 05 2019
accepted: 17 05 2019
pubmed: 4 6 2019
medline: 30 7 2020
entrez: 4 6 2019
Statut: ppublish

Résumé

Combination therapy with a calcineurin inhibitor (CNI), such as cyclosporine (CSA) or tacrolimus (Tac), and methotrexate (MTX) or mycophenolate mofetil (MMF) is a widely used approach to graft-versus-host disease (GVHD) prevention. Data on the comparative effectiveness of MMF compared with MTX are limited and conflicting, however. We analyzed data from the Center for International Blood and Marrow Transplant Research for adult patients undergoing first myeloablative hematopoietic cell transplantation (HCT) from an HLA-identical matched related donor (MRD; n = 3979) or matched unrelated donor (URD; n = 4163) using CSA+MMF, CSA+MTX, Tac+MMF, or Tac+MTX for GVHD prevention between 2000 and 2013. Within the MRD cohort, 2252 patients received CSA+MTX, 1391 received Tac+MTX, 114 received CSA+MMF, and 222 received Tac+MMF. Recipients of CSA+MMF had a higher incidence of acute GVHD grade II-IV (hazard ratio [HR], 1.65; 95% confidence interval [CI], 1.24 to 2.20; P < .001) and grade III-IV (HR, 1.92; 95% CI, 1.31 to 2.83; P < .001) compared with Tac+MTX. The use of CSA+MMF was also associated with inferior overall survival (OS) (HR, 2.31; 95% CI, 1.73 to 3.09; P < .001) due to higher transplantation-related mortality (TRM) (HR, 4.03; 95% CI, 2.61 to 6.23; P < .001) compared with Tac+MTX. Within the URD cohort, 974 patients received CSA+MTX, 2697 received Tac+MTX, 68 received CSA+MMF, and 424 received Tac+MMF. CSA+MMF was again significantly associated with a higher incidence of grade III-IV acute GVHD (HR, 2.31; 95% CI, 1.57 to 3.42; P <0001), worse OS (HR, 2.36; 95% CI, 1.67 to 3.35; P < .001), and higher TRM (HR, 3.09; 95% CI, 2.00 to 4.77; P < .001), compared with Tac+MTX and other regimens. Thus, this large retrospective comparison of MMF versus MTX in combination with CSA or Tac demonstrates significantly worse GVHD and survival outcomes with CSA+MMF compared with Tac+MTX.

Identifiants

DOI: 10.1016/j.bbmt.2019.05.019 PMID: 31158502 PMC: PMC7039394
pubmed: 31158502
pii: S1083-8791(19)30330-1
doi: 10.1016/j.bbmt.2019.05.019
pmc: PMC7039394
mid: NIHMS1550134
pii:
doi:

Substances chimiques

Cyclosporine 83HN0GTJ6D
Mycophenolic Acid HU9DX48N0T

Types de publication

Comparative Study Journal Article Multicenter Study Research Support, N.I.H., Extramural

Langues

eng

Sous-ensembles de citation

IM

Pagination

1744-1755

Subventions

Organisme : NCI NIH HHS
ID : U24 CA076518
Pays : United States

Informations de copyright

Copyright © 2019. Published by Elsevier Inc.

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Auteurs

Betty K Hamilton (BK)

Blood and Marrow Transplant Program, Cleveland Clinic Taussig Cancer Institute, Cleveland, Ohio, USA. Electronic address: hamiltb2@ccf.org.

Ying Liu (Y)

Medical College of Wisconsin, Milwaukee, Wisconsin, USA.

Michael T Hemmer (MT)

Medical College of Wisconsin, Milwaukee, Wisconsin, USA.

Navneet Majhail (N)

Blood and Marrow Transplant Program, Cleveland Clinic Taussig Cancer Institute, Cleveland, Ohio, USA.

Olle Ringden (O)

Translational Cell Therapy Group, Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.

Dennis Kim (D)

Princess Margaret Cancer Center-BMT Program, Toronto, Ontario, Canada.

Luciano Costa (L)

Division of Hematology/Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA.

Robert Stuart (R)

Medical University of South Carolina, Charleston, South Carolina, USA.

Amin Alousi (A)

Department of Stem Cell Transplantation, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.

Joseph A Pidala (JA)

H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA.

Daniel R Couriel (DR)

Utah Blood and Marrow Transplant Program-Adults, Salt Lake City, Utah, USA.

Mahmoud Aljurf (M)

Department of Oncology, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia.

Joseph H Antin (JH)

Division of Hematologic Malignancies, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA.

Christopher Bredeson (C)

The Ottawa Hospital Blood and Marrow Transplant Program and the Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.

Jean-Yves Cahn (JY)

Department of Hematology, CHU Grenoble Alpes, Grenoble, France.

Mitchell Cairo (M)

Division of Pediatric Hematology, Oncology and Stem Cell Transplantation, Department of Pediatrics, New York Medical College, Valhalla, New York.

Sung Won Choi (SW)

The University of Michigan, Ann Arbor, Michigan, USA.

Christopher Dandoy (C)

Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.

Robert Peter Gale (RP)

Hematology Research Centre, Division of Experimental Medicine, Department of Medicine, Imperial College London, London, United Kingdom.

Usama Gergis (U)

Hematolgic Malignancies & Bone Marrow Transplant, Department of Medical Oncology, New York Presbyterian Hospital/Weill Cornell Medical Center, New York, New York, USA.

Peiman Hematti (P)

Division of Hematology/Oncology/Bone Marrow Transplantation, Department of Medicine, University of Wisconsin, Madison, Wisconsin, USA.

Yoshihiro Inamoto (Y)

Division of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan.

Rammurti T Kamble (RT)

Division of Hematology and Oncology, Center for Cell and Gene Therapy, Baylor College of Medicine, Houston, Texas, USA.

Margaret MacMillan (M)

University of Minnesota Blood and Marrow Transplant Program-Pediatrics/Adults, Minneapolis, Minnesota, USA.

David I Marks (DI)

Adult Bone Marrow Transplant, University Hospitals Bristol NHS Trust, Bristol, United Kingdom.

Eneida Nemecek (E)

Pediatric Blood & Marrow Transplant Program, Department of Pediatrics, Doernbecher Children's Hospital and Oregon Health & Science University, Portland, Oregon, USA.

Taiga Nishihori (T)

Department of Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA.

Ayman Saad (A)

Division of Hematology, Ohio State University, Columbus, Ohio, USA.

Bipin N Savani (BN)

Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA.

Jeff Schriber (J)

Cancer Transplant Institute, Virginia G. Piper Cancer Center, Scottsdale, Arizona, USA; Arizona Oncology, Scottsdale, Arizona, USA.

Sachiko Seo (S)

Department of Hematology and Oncology, Dokkyo Medical University, Mibu, Japan.

Gérard Socié (G)

Department of Hematology, Hopital Saint Louis, Paris, France.

Takanori Teshima (T)

Hokkaido University Hospital, Sapporo, Japan.

Leo F Verdonck (LF)

Department of Hematology/Oncology, Isala Clinic, Zwolle, The Netherlands.

Edmund K Waller (EK)

Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia, USA.

Mona Wirk (M)

Division of Bone Marrow Transplant, Seattle Cancer Care Alliance, Seattle, Washington, USA.

Stephen R Spellman (SR)

Center for International Blood and Marrow Transplant Research-Minneapolis, Minneapolis, Minnesota, USA.

Mukta Arora (M)

Division of Hematology, Oncology and Transplantation, Department of Medicine, University of Minnesota Medical Center, Minneapolis, Minnesota, USA.

Saurabh Chhabra (S)

Center for International Blood and Marrow Transplant Research-Milwaukee, Milwaukee, Wisconsin, USA; Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.

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Classifications MeSH

questionsmedicales.fr › Personnes › Tranches d'âge › Adolescent › Inferior Outcomes with Cyclosporine and...
questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Inferior Outcomes with Cyclosporine and...
questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Sujet âgé › Inferior Outcomes with Cyclosporine and...
questionsmedicales.fr › Régions du corps › Transplants › Allogreffes › Inferior Outcomes with Cyclosporine and...
questionsmedicales.fr › Acides aminés, peptides et protéines › Peptides › Peptides cycliques › Cyclosporines › Ciclosporine › Inferior Outcomes with Cyclosporine and...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Statistiques comme sujet › Analyse de survie › Survie sans rechute › Inferior Outcomes with Cyclosporine and...
questionsmedicales.fr › Maladies du système immunitaire › Maladie du greffon contre l'hôte › Inferior Outcomes with Cyclosporine and...
questionsmedicales.fr › Procédures de chirurgie opératoire › Transplantation › Transplantation cellulaire › Transplantation de cellules souches › Transplantation de cellules souches hématopoïétiques › Inferior Outcomes with Cyclosporine and...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Inferior Outcomes with Cyclosporine and...
questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Adulte d'âge moyen › Inferior Outcomes with Cyclosporine and...
questionsmedicales.fr › Lipides › Acides gras › Acide mycophénolique › Inferior Outcomes with Cyclosporine and...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Collecte de données › Registre civil › Mortalité › Taux de survie › Inferior Outcomes with Cyclosporine and...