GVHD prophylaxis by tacrolimus and mini-MTX in single-unit CBT: a single institute experience
- PDF / 658,068 Bytes
- 6 Pages / 595.276 x 790.866 pts Page_size
- 46 Downloads / 155 Views
ORIGINAL ARTICLE
GVHD prophylaxis by tacrolimus and mini‑MTX in single‑unit CBT: a single institute experience Shigeo Fuji1 · Yuma Tada1 · Ryo Nakata1 · Keiichi Nakata1 · Midori Koike1 · Shuhei Kida1 · Kazuhito Tsutsumi1 · Hiroaki Masaie1 · Hitoshi Yoshida1 · Jun Ishikawa1 Received: 2 July 2019 / Revised: 15 October 2019 / Accepted: 16 October 2019 © Japanese Society of Hematology 2019
Abstract Tacrolimus (TAC) combined with short-term methotrexate (MTX) is widely used to prevent graft-versus-host disease (GVHD) in cord blood transplantation (CBT). As short-term MTX aggravates mucositis and delays engraftment, we reduced the dose of MTX, as previously reported in the non-CBT setting. Here, we retrospectively analyze outcomes of 20 patients who received CBT from April 2017 to December 2018. All patients received TAC with mini-MTX as GVHD prophylaxis. Mini-MTX was administered at a dose of 5 mg/m2 of MTX on days 1, 3 and 6 after CBT. Median age was 54.5 years. Median follow-up time in surviving patients was 396 days. The primary disease was acute leukemia (n = 12) or malignant lymphoma (n = 8). Three patients and 17 patients received myeloablative and reduced-intensity conditioning, respectively. Rate and median time to engraftment of neutrophils were 90.0% and 20.5 days, respectively. Cumulative incidences of grade II–IV and grade III–IV acute GVHD were 35.0% and 5.0%, respectively. At one year after CBT, the overall survival rate was 80.5%, cumulative incidence of relapse/progression was 15.0%, and non-relapse mortality rate was 5.0%. In conclusion, TAC with mini-MTX may be a promising GVHD prophylaxis regimen in single-unit CBT. Keywords Cord blood transplant · Methotrexate · Graft failure · GVHD prophylaxis
Introduction Cord blood transplant (CBT) is currently an established alternative donor source for hematopoietic stem cell transplantation (HCT) [1]. In CBT, there is still controversy about the choice of drugs for GVHD prophylaxis, i.e., calcineurin inhibitor plus methotrexate (MTX) vs. mycophenolate mofetil (MMF) [2, 3]. MTX-containing regimen was associated with a significantly lower incidence of acute GVHD but a higher incidence of graft failure (GF) than MMF-containing regimen [2, 3]. Meanwhile, MMF-containing regimen was reported to be associated with a higher incidence of HHV6 encephalitis in CBT, which is associated with high transplant-related mortality and long-term cognitive sequelae [4, 5]. There was no statistically significant difference in terms of overall survival (OS) between MTX and MMF.
In order to reduce the toxicity of short-term MTX, several studies assessed whether the dose of MTX can be reduced without impairing the clinical potency of GVHD prophylaxis. In the setting of other stem cell sources such as bone marrow, tacrolimus (TAC) plus mini-dose MTX was reported to be associated with less toxicity and equivalent incidence of GVHD as standard-dose MTX [6, 7]. It is reasonable to reduce the dose of MTX in CBT, as GF is still a major problem in CBT and the incidence of severe GVHD i
Data Loading...
