Cyclosporine/methotrexate versus tacrolimus/methotrexate with or without anti-thymocyte globulin as GVHD prophylaxis in
- PDF / 590,986 Bytes
- 12 Pages / 595.276 x 790.866 pts Page_size
- 103 Downloads / 239 Views
ORIGINAL ARTICLE
Cyclosporine/methotrexate versus tacrolimus/methotrexate with or without anti-thymocyte globulin as GVHD prophylaxis in adult patients with aplastic anemia Yasushi Onishi 1 & Takehiko Mori 2 & Hirohito Yamazaki 3 & Katsuto Takenaka 4 & Hiroki Yamaguchi 5 & Naoki Shingai 6 & Yukiyasu Ozawa 7 & Hiroatsu Iida 8 & Shuichi Ota 9 & Naoyuki Uchida 10 & Toshihiro Miyamoto 11 & Yuta Katayama 12 & Jun Kato 2 & Satoshi Yoshioka 13 & Makoto Onizuka 14 & Tatsuo Ichinohe 15 & Yoshiko Atsuta 16 & on behalf of the Adult Aplastic Anemia Working Group of the Japan Society for Hematopoietic Cell Transplantation Received: 21 July 2020 / Accepted: 28 September 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract The impact of calcineurin inhibitor types and anti-thymocyte globulin (ATG) in conditioning on overall survival (OS) and GVHD-free, relapse-free survival (GRFS) has not yet been analyzed in detail for aplastic anemia. We herein examined 517 adult patients with aplastic anemia who underwent BMT from HLA-matched sibling donors (MSD, n = 255) and unrelated donors (UD, n = 262) and were treated with cyclosporine A (CSA) + methotrexate (MTX) (n = 258) and tacrolimus (TAC) + MTX (n = 259). In total, 330 patients received ATG in conditioning. CSA + MTX versus TAC + MTX did not have a significant impact on acute and chronic GVHD, OS, or GRFS in each donor type. The use of ATG in conditioning reduced the risk of grade II–IV acute GVHD in the MSD and UD cohorts (HR 0.42, P = 0.014, and HR 0.3, P < 0.001, respectively); however, a differential impact on GRFS was identified, namely, better GRFS in MSD recipients (HR 0.56, P = 0.016), but not in UD recipients (HR 1.1, P = 0.657). In conclusion, CSA + MTX and TAC + MTX were similar as GVHD prophylaxis regardless of the donor type, and ATG in conditioning increased GRFS in MSD transplants, but not in UD transplants. Keywords Aplastic anemia . Cyclosporine . Tacrolimus . Anti-thymocyte globulin . GRFS
Introduction Allogeneic hematopoietic cell transplantation (allo-HCT) from HLA-matched sibling donors (MSD) is the first-line treatment for younger patients with aplastic anemia and a second-line treatment for older patients who do not respond to immunosuppressive therapy (IST) with anti-thymocyte globulin (ATG) and cyclosporine A (CSA) or a thrombopoietin receptor agonist (TPORA) treatment. ISTand TPORA-refractory patients lacking MSD are considered for allo-HCT from unrelated donors (UD) as a salvage treatment [1–4]. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00277-020-04290-1) contains supplementary material, which is available to authorized users. * Yasushi Onishi [email protected] Extended author information available on the last page of the article
Graft-versus-host disease (GVHD) impairs quality of life and causes transplant-related mortality (TRM). The combination of CSA with methotrexate (CSA + MTX) is a standard regimen of prophylaxis for GVHD in patients with aplastic anemia. In random
Data Loading...
