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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.
- Source :
-
Bone marrow transplantation [Bone Marrow Transplant] 2017 Mar; Vol. 52 (3), pp. 423-430. Date of Electronic Publication: 2016 Dec 12. - Publication Year :
- 2017
-
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.
- Subjects :
- Adolescent
Adult
Cyclosporine administration & dosage
Disease-Free Survival
Female
Humans
Incidence
Japan
Leukemia, Myeloid, Acute mortality
Leukemia, Myeloid, Acute therapy
Male
Middle Aged
Precursor Cell Lymphoblastic Leukemia-Lymphoma mortality
Precursor Cell Lymphoblastic Leukemia-Lymphoma therapy
Registries
Survival Rate
Tacrolimus administration & dosage
Cord Blood Stem Cell Transplantation
Graft vs Host Disease mortality
Graft vs Host Disease prevention & control
Methotrexate administration & dosage
Mycophenolic Acid administration & dosage
Subjects
Details
- Language :
- English
- ISSN :
- 1476-5365
- Volume :
- 52
- Issue :
- 3
- Database :
- MEDLINE
- Journal :
- Bone marrow transplantation
- Publication Type :
- Academic Journal
- Accession number :
- 27941766
- Full Text :
- https://doi.org/10.1038/bmt.2016.255