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Improved outcomes using tacrolimus/sirolimus for graft-versus-host disease prophylaxis with a reduced-intensity conditioning regimen for allogeneic hematopoietic cell transplant as treatment of myelofibrosis.
- Source :
-
Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation [Biol Blood Marrow Transplant] 2010 Feb; Vol. 16 (2), pp. 281-6. Date of Electronic Publication: 2009 Sep 26. - Publication Year :
- 2010
-
Abstract
- Allogeneic hematopoietic cell transplantation (HCT) using reduced-intensity conditioning (RIC) regimens is a potentially curative treatment for patients (patients) with myelofibrosis (MF), as we and others have reported. Nonrelapse mortality (NRM) from graft-versus-host disease (GVHD) and other complications has limited the success of this approach. As part of an ongoing prospective research study at City of Hope, a combination of tacrolimus/sirolimus +/- methotrexate (MTX) for GVHD prophylaxis has become the standard treatment for our allogeneic HCT patients. In this report, we present results for 23 consecutive patients, including extended follow up for 9 patients previously reported who received cyclosporine (CsA)/mycophenolate moffetil (MMF)+/-MTX, and the current series of 14 patients who received tacrolimus/sirolimus+/-MTX, and evaluate the impact of the GVHD prophylaxis regimen on the outcomes. Median follow-up for alive patients was 29.0 months (9.5-97.0). The estimated 2-year overall survival (OS) for the CsA/MMF cohort was 55.6% (confidence interval 36.0, 71.3), and for the tacrolimus/sirolimus cohort it was 92.9% (63.3, 98.8) (P=.047). The probability of grade III or IV acute GVHD (aGVHD) was 60% for the CsA/MMF patients, and 10% for the tacrolimus/sirolimus group (P=.0102). No significant differences were seen for grade II to IV aGVHD in the 2 groups. We conclude that the combination of tacrolimus/sirolimus+/-MTX for GVHD prophylaxis in the setting of RIC HCT for MF appears to reduce the incidence of severe aGVHD and NRM, and leads to improved OS compared to CSA/MMF+/-MTX.<br /> (Copyright 2010 American Society for Blood and Marrow Transplantation. Published by Elsevier Inc. All rights reserved.)
- Subjects :
- Adult
Aged
Cohort Studies
Drug Therapy, Combination
Female
Follow-Up Studies
Graft vs Host Disease epidemiology
Graft vs Host Disease mortality
Humans
Male
Methotrexate therapeutic use
Middle Aged
Peripheral Blood Stem Cell Transplantation adverse effects
Severity of Illness Index
Survival Analysis
Transplantation, Homologous
Treatment Outcome
Graft vs Host Disease prevention & control
Hematopoietic Stem Cell Transplantation adverse effects
Immunosuppressive Agents therapeutic use
Primary Myelofibrosis therapy
Sirolimus therapeutic use
Tacrolimus therapeutic use
Transplantation Conditioning methods
Subjects
Details
- Language :
- English
- ISSN :
- 1523-6536
- Volume :
- 16
- Issue :
- 2
- Database :
- MEDLINE
- Journal :
- Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation
- Publication Type :
- Academic Journal
- Accession number :
- 19786111
- Full Text :
- https://doi.org/10.1016/j.bbmt.2009.09.020