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
Chhabra, Saurabh (Medical College of Wisconsin)
Liu, Ying (Medical College of Wisconsin)
Hemmer, Michael T. (Medical College of Wisconsin)
Costa, Luciano (University of Alabama at Birmingham. Department of Medicine)
Pidala, Joseph A. (H. Lee Moffitt Cancer Center and Research Institute)
Couriel, Daniel R. (Utah Blood and Marrow Transplant Program)
Alousi, Amin M. (University of Texas MD Anderson Cancer Center)
Majhail, Navneet S. (Cleveland Clinic Taussig Cancer Institute)
Stuart, Robert K. (Medical University of South Carolina)
Kim, Dennis (Princess Margaret Cancer Center)
Ringden, Olle (Karolinska Institutet (Estocolm, Suècia). Division of Therapeutic Immunology)
Urbano Ispizua, Álvaro (Institut Germans Trias i Pujol. Institut de Recerca contra la Leucèmia Josep Carreras)
Saad, Ayman (University of Alabama at Birmingham)
Savani, Bipin N. (Vanderbilt University Medical Center)
Cooper, Brenda (University Hospitals Case Medical Center. Department of Medicine-Hematology and Oncology)
Marks, David I. (University Hospitals Bristol NHS Trust)
Socie, Gerard (Hôpital Saint Louis. Department of Hematology)
Schouten, Harry C. (Academische Ziekenhuis. Department of Hematology)
Schoemans, Helene (University Hospitals Leuven (Bèlgica))
Abdel-Azim, Hisham (University of Southern California Keck School of Medicine)
Yared, Jean (University of Maryland. Greenebaum Cancer Center)
Cahn, Jean-Yves (CHU Grenoble Alpes. Department of Hematology)
Wagner, John (Thomas Jefferson University. Department of Medical Oncology)
Antin, Joseph H. (Dana-Farber Cancer Institute (Boston, Estats Units d'Amèrica))
Verdonck, Leo F. (Isala Clinic. Departmentt of Hematology/Oncology)
Lehmann, Leslie (Dana-Farber Cancer Institute (Boston, Estats Units d'Amèrica))
Aljurf, Mahmoud (King Faisal Specialist Hospital and Research Centre (Aràbia Saudita))
MacMillan, Margaret L. (University of Minnesota Blood and Marrow Transplant Program)
Litzow, Mark R. (Mayo Clinic Rochester. Division of Hematology and Transplant Center)
Solh, Melhem M. (Northside Hospital. Blood and Marrow Transplant Group of Georgia)
Qayed, Muna (Emory University School of Medicine. Department of Pediatrics)
Hematti, Peiman (University of Wisconsin)
Kamble, Rammurti T. (Baylor College of Medicine)
Vij, Ravi (Washington University School of Medicine. Division of Hematology and Oncology)
Hayashi, Robert J. (Washington University School of Medicine in St. Louis. Division of Pediatric Hematology/Oncology)
Gale, Robert Peter (Imperial College London. Hematology Research Centre)
Martino Bofarull, Rodrigo (Institut d'Investigació Biomèdica Sant Pau)
Seo, Sachiko (National Cancer Research Center East)
Hashmi, Shahrukh K (Mayo Clinic Rochester. Division of Hematology and Transplant Center)
Nishihori, Taiga (H. Lee Moffitt Cancer Center and Research Institute)
Teshima, Takanori (Kyushu University Hospital)
Gergis, Usama (New York Presbyterian Hospital/Weill Cornell Medical Center. Department of Medical Oncology)
Inamoto, Yoshihiro (National Cancer Center Hospital)
Spellman, Stephen R. (Center for International Blood and Marrow Transplant Research)
Arora, Mukta (University of Minnesota Medical Center)
Hamilton, Betty K. (Cleveland Clinic Taussig Cancer Institute)
Universitat Autònoma de Barcelona

Data:	2019
Resum:	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.
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra, i la creació d'obres derivades, sempre que no sigui amb finalitats comercials i que es distribueixin sota la mateixa llicència que regula l'obra original. Cal que es reconegui l'autoria de l'obra original.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Matèria:	Allogeneic hematopoietic cell transplantation ; Calcineurin inhibitor Tacrolimus ; Cyclosporine ; Graft-versus-host disease prophylaxis ; Methotrexate ; Mycophenolate mofetil ; Reduced-intensity conditioning
Publicat a:	Biology of blood and marrow transplantation, Vol. 25 Núm. 1 (january 2019) , p. 73-85, ISSN 1523-6536

DOI: 10.1016/j.bbmt.2018.08.018
PMID: 30153491

13 p, 850.9 KB

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