Exploratory research for optimal GvHD prophylaxis after single unit CBT in adults: Short-term methotrexate reduced the incidence of severe GvHD more than mycophenolate mofetil

Japan Society for Hematopoietic Cell Transplantation GvHD working group

Research output: Contribution to journalArticle

18 Citations (Scopus)

Abstract

In order to examine GvHD prophylaxis in umbilical cord blood transplantation (UCBT) in more detail, we compared transplant outcomes after UCBT for acute leukemia among GvHD prophylaxes using registry data. We selected patients transplanted with a calcineurin inhibitor and methotrexate (MTX)/mycophenolate mofetil (MMF) combination. A total of 1516 first myeloablative UCBT between 2000 and 2012 (Cyclosporine A (CyA) plus MTX, 824, Tacrolimus (Tac) plus MTX, 554, Tac plus MMF, 138) were included. With adjusted analyses, Tac plus MMF showed a significantly higher risk for grade II-IV and III-IV acute GvHD than CyA or Tac plus MTX. Although NRM was similar, Tac plus MMF showed a significantly lower risk of relapse than CyA or Tac plus MTX. A significant difference was observed in the risk of overall mortality (OM) between the MTX-containing group and MMF-containing group. In patients with standard-risk disease, there was no significant difference in the risk of OM in any GvHD prophylaxis. However, in patients with advanced-risk disease, Tac plus MMF showed a significantly lower risk of OM. Therefore, MTX-containing prophylaxis is preferred in UCBT for standard-risk disease, whereas MMF-containing prophylaxis is preferred for advanced-risk disease. A prospective study to identify optimal GvHD prophylaxis for UCBT is warranted.

Original languageEnglish
Pages (from-to)423-430
Number of pages8
JournalBone Marrow Transplantation
Volume52
Issue number3
DOIs
Publication statusPublished - 2017 Mar 1

ASJC Scopus subject areas

  • Hematology
  • Transplantation

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