Abstract
For recipients of allogeneic hematopoietic stem cell transplant (HSCT), mycophenolate mofetil (MMF) plus tacrolimus combination is mostly used in reduced-intensity (RIC), and nonmyeloablative conditioning (NMAC) whereas methotrexate and tacrolimus combination is preferred in myeloablative conditioning (MAC). We present single institution outcomes in patients undergoing allogeneic HSCT with both MAC and NMAC/RIC regimen using MMF and tacrolimus for graft-versus-host disease (GVHD) prophylaxis. Data from all adult patients who underwent allogeneic HSCT from 2007 to 2017 was collected from Data Back to Centers web-based application of Center for International Blood and Marrow Transplant Research (CIBMTR). A total of 150 patients were included with the mean age of 46.9 years. For the patients who received MAC (n=109), the cumulative incidence of grade II-IV acute GVHD at day 100 was 37%, grade II-IV acute GVHD at one year was 51%, and chronic GVHD at one year was 38%. For the patients who received NMAC/RIC (n=41), the cumulative incidence of grade II-IV acute GVHD at day 100 was 31%, grade II-IV acute GVHD at one year was 28%, and chronic GVHD at one year was 36%. This institutional analysis shows that the combination of MMF and tacrolimus yields acceptable outcomes for the prevention of acute and chronic GVHD.
Highlights
Graft-versus-host disease (GVHD) is a serious and challenging complication of allogeneic hematopoietic stem cell transplant (HSCT)
Since acute GVHD remains a major threat to a successful outcome after allogeneic HSCT and because treatment of acute GVHD can be challenging, the use of appropriate prophylaxis is of paramount significance in the care of these patients
The combination of tacrolimus and mycophenolate mofetil (MMF) has been evaluated for acute GVHD prophylaxis in both adult and pediatric patient populations undergoing matched sibling donor allogeneic HSCT after myeloablative conditioning (MAC) and nonmyeloablative conditioning (NMAC) regimens [7, 8]
Summary
Graft-versus-host disease (GVHD) is a serious and challenging complication of allogeneic hematopoietic stem cell transplant (HSCT). In a study reported by Hamilton et al, combination MMF and cyclosporine, when compared with MTX and cyclosporine for patients undergoing myeloablative matched sibling donor transplant, had a similar relapse, non-relapse mortality and overall survival but a higher incidence of grade III-IV acute GVHD [4]. The combination of tacrolimus and MMF has been evaluated for acute GVHD prophylaxis in both adult and pediatric patient populations undergoing matched sibling donor allogeneic HSCT after myeloablative conditioning (MAC) and nonmyeloablative conditioning (NMAC) regimens [7, 8]. A recent publication by Chhabra et al evaluating outcomes in patients undergoing allogeneic HSCT with reduced intensity (RIC) comparing calcineurin inhibitor (CNI)-MMF and CNI-MTX based regimens reported similar outcomes with matched sibling donors but higher acute GVHD with CNI-MMF combination for unrelated donors (URD) [8]. We report clinical outcomes in patients who underwent allogeneic HSCT and received tacrolimus and MMF for GVHD prophylaxis
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