Myeloablative Cord Blood Transplantation for Adults With Hematological Malignancies Using Tacrolimus and Short-Term Methotrexate for Graft-Versus-Host Disease Prophylaxis: Single-Institution Analysis

M. F. Yamada, K. Miyamura, T. Fujiwara, K. Kohata, Yoko Okitsu, H. Ohguchi, J. Yamamoto, H. Yokoyama, Y. Tomiya, K. Ishizawa, Junichi Kameoka, H. Harigae

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Abstract

We studied clinical outcomes of 25 adult patients with hematological malignancies who underwent cord blood transplantation (CBT) after a myeloablative conditioning regimen, including high-dose cytosine arabinoside (CA) (8 g/m2), cyclophosphamide (CY) (120 mg/kg), and total-body irradiation (TBI) (12 Gy). For graft-versus-host disease (GVHD) prophylaxis, all patients received a combination of tacrolimus and short-term methotrexate (sMTX). Neutrophil engraftment was achieved in 20 of 25 patients. Of the 22 evaluable patients, 2 and 7 had grades I and II acute GVHD, respectively, and only 1 developed grade III acute GVHD after discontinuation of tacrolimus due to encephalopathy. Chronic GVHD developed in 13 of 19 evaluable patients, including 4 with the extensive type. However, the Karnofsky scores of survivors at 1 year after CBT were 90% or 100%. Eight of 25 patients died of nonrelapse causes (n = 4) and relapse/progressive disease (n = 4); 17 patients are currently alive with 15 free of disease at the present time (median follow-up, 24 months). The probability of disease-free survival at 2 years among patients with standard risk was 89% and that of high-risk patients was 30%. Transplantation-related mortality within 100 days was 12%. These results suggested that the CA/CY/TBI combination is a promising conditioning regimen for myeloablative CBT. Furthermore, tacrolimus and sMTX seemed to have suppressed severe acute GVHD and chronic GVHD, which may also contribute to the favorable results.

Original languageEnglish
Pages (from-to)3637-3642
Number of pages6
JournalTransplantation Proceedings
Volume40
Issue number10
DOIs
Publication statusPublished - 2008 Dec 1

ASJC Scopus subject areas

  • Surgery
  • Transplantation

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