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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, Álvaro 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 MacMillan, Margaret L. Litzow, Mark R. Solh, Melhem M. Qayed, Muna Hematti, Peiman Kamble, Rammurti T. Vij, Ravi Hayashi, Robert J. Gale, Robert Peter 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 Medicaments Cèl·lules mare Empelts de teixits Myeloid leukemia Chronic lymphocytic leukemia Drugs 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: https://doi.org/10.1016/j.bbmt.2018.08.018 |
It is part of: | Biology of Blood and Marrow Transplantation, 2019, vol. 25, num. 1, p. 73-85 |
URI: | http://hdl.handle.net/2445/178349 |
Related resource: | https://doi.org/10.1016/j.bbmt.2018.08.018 |
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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