1. Comparative Study of Tacrolimus and Short-Term Methotrexate: 2-Day versus 3-Day Methotrexate as Graft-versus-Host-Disease Prophylaxis after Umbilical Cord Blood Transplantation in Adults
- Author
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Maasa Abe, Bungo Saito, Kouji Yanagisawa, Ayaka Nakata, Shun Fujiwara, Yuta Baba, Tsuyoshi Nakamaki, Norimichi Hattori, Yui Uto, Nana Arai, Yukiko Kawaguchi, Tomoharu Matsui, Shotaro Shimada, Nobuyuki Kabasawa, Yohei Sasaki, Megumi Watanuki, So Murai, Hiroyuki Tsukamoto, and Hiroshi Harada
- Subjects
Adult ,medicine.medical_specialty ,Graft vs Host Disease ,chemical and pharmacologic phenomena ,Lower risk ,Gastroenterology ,Tacrolimus ,03 medical and health sciences ,0302 clinical medicine ,Japan ,Internal medicine ,medicine ,Humans ,Retrospective Studies ,Transplantation ,Univariate analysis ,Neutrophil Engraftment ,business.industry ,Umbilical Cord Blood Transplantation ,Hematology ,medicine.disease ,Calcineurin ,Methotrexate ,Graft-versus-host disease ,030220 oncology & carcinogenesis ,Cord Blood Stem Cell Transplantation ,business ,030215 immunology ,medicine.drug - Abstract
Methotrexate (MTX) in combination with a calcineurin inhibitor has been commonly used for prophylaxis of graft-versus-host disease (GVHD) following umbilical cord blood transplantation (UCBT) in Japan. However, the appropriate prophylactic MTX dosage in UCBT has not been established to date. To determine the preferential GVHD prophylaxis in UCBT, this study retrospectively investigated the administration of short-term MTX for 2 days versus 3 days. Of 103 adult patients submitted to UCBT enrolled in the study, 73 received tacrolimus (TAC) with 2 days of MTX given at 10 mg/m2 on day 1 and 7 mg/m2 on day 3 (very short-term [vs] MTX), whereas 30 patients received TAC with 3 days of MTX given at 10 mg/m2 on day 1, 7 mg/m2 on day 3, and 7 mg/m2 on day 6 (short-term [s] MTX). In univariate analysis, neutrophil engraftment was shown to be significantly better (P = .039) in the vsMTX/TAC group. Among high-risk patients, the vsMTX/TAC group also exhibited earlier neutrophil engraftment (P = .042); however, the incidence of acute GVHD was higher in the vsMTX/TAC group (P = .035) on univariate analysis. In multivariate analysis, compared with sMTX/TAC, vsMTX/TAC was associated with lower risk of relapse (hazard ratio, .27; 95% confidence interval, .11 to .64; P = .003) . These results suggest that vsMTX/TAC can be appropriate GVHD prophylaxis after UCBT, especially in higher-risk patients.
- Published
- 2020