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Title: Comparative analysis of calcineurin-inhibitor-based methotrexate and mycophenolate mofetil-containing regimens for prevention of Graft-versus-Host Disease after reduced intensity conditioning allogeneic transplantation
Author: Chhabra, Saurabh
Liu, Ying
Hemmer, Michael T.
Costa, Luciano
Pidala, Joseph A.
Couriel, Daniel R.
Alousi, Amin M.
Majhail, Navneet S.
Stuart, Robert K.
Kim, Dennis
Ringden, Olle
Urbano Ispizua, Alvaro
Saad, Ayman
Savani, Bipin N.
Cooper, Brenda
Marks, David I.
Socie, Gerard
Schouten, Harry C.
Schoemans, Helen
Abdel Azim, Hisham
Yared, Jean
Cahn, Jean Yves
Wagner, John
Antin, Joseph H.
Verdonck, Leo F.
Lehmann, Leslie
Aljurf, Mahmoud D.
MacMillan, Margaret L.
Litzow, Mark R.
Solh, Melhem M.
Qayed, Muna
Hematti, Peiman
Kamble, Rammurti T.
Vij, Ravi
Hayashi, Robert J.
Gale, Robert P.
Martino, Rodrigo
Seo, Sachiko
Hashmi, Shahrukh K.
Nishihori, Taiga
Teshima, Takanori
Gergis, Usama
Inamoto, Yoshihiro
Spellman, Stephen R.
Arora, Mukta
Hamilton, Betty K
Keywords: Leucèmia mieloide
Leucèmia limfocítica crònica
Cèl·lules mare
Empelts de teixits
Myeloid leukemia
Chronic lymphocytic leukemia
Stem cells
Tissue transplantation
Issue Date: 1-Jan-2019
Publisher: Elsevier
Abstract: The combination of a calcineurin inhibitor (CNI) such as tacrolimus (TAC) or cyclosporine (CYSP) with methotrexate (MTX) or with mycophenolate mofetil (MMF) has been commonly used for graft-versus-host disease (GVHD) prophylaxis after reduced-intensity conditioning (RIC) allogeneic hematopoietic cell transplantation (alloHCT), but there are limited data comparing efficacy of the 2 regimens. We evaluated 1564 adult patients who underwent RIC alloHCT for acute myelogenous leukemia (AML) and acute lymphoblastic leukemia (ALL), chronic myelogenous leukemia (CML), and myelodysplastic syndrome (MDS) from 2000 to 2013 using HLA-identical sibling (matched related donor [MRD]) or unrelated donor (URD) peripheral blood graft and received CYSP or TAC with MTX or MMF for GVHD prophylaxis. Primary outcomes of the study were acute and chronic GVHD and overall survival (OS). The study divided the patient population into 4 cohorts based on regimen: MMF-TAC, MMF-CYSP, MTX-TAC, and MTX-CYSP. In the URD group, MMF-CYSP was associated with increased risk of grade II to IV acute GVHD (relative risk [RR], 1.78; P < .001) and grade III to IV acute GVHD (RR, 1.93; P = .006) compared with MTX-TAC. In the URD group, use of MMF-TAC (versus MTX-TAC) lead to higher nonrelapse mortality. (hazard ratio, 1.48; P = .008). In either group, no there was no difference in chronic GVHD, disease-free survival, and OS among the GVHD prophylaxis regimens. For RIC alloHCT using MRD, there are no differences in outcomes based on GVHD prophylaxis. However, with URD RIC alloHCT, MMF-CYSP was inferior to MTX-based regimens for acute GVHD prevention, but all the regimens were equivalent in terms of chronic GVHD and OS. Prospective studies, targeting URD recipients are needed to confirm these results.
Note: Versió postprint del document publicat a:
It is part of: Biology of Blood and Marrow Transplantation, 2019, vol. 25, num. 1, p. 73-85
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ISSN: 1083-8791
Appears in Collections:Articles publicats en revistes (Medicina)
Articles publicats en revistes (IDIBAPS: Institut d'investigacions Biomèdiques August Pi i Sunyer)

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