Comparison of cyclosporine and tacrolimus combined with mycophenolate mofetil in prophylaxis for graft-versus-host disease after reduced-intensity umbilical cord blood transplantation.

Abstract

Umbilical cord blood transplantation with a reduced-intensity conditioning regimen (RIC-UCBT) is used increasingly in patients who have comorbid organ functions and lack human leukocyte antigen-identical donors. We compared the outcomes in 35 patients who received mycophenolate mofetil plus cyclosporine (MMF/CSP, n = 17) or MMF plus tacrolimus (MMF/TAC, n = 18) for graft-versus-host disease (GVHD) prophylaxis after RIC-UCBT. Cumulative incidence of neutrophil engraftment was 94 and 89 % in MMF/CSP and MMF/TAC groups, respectively (p = 0.34). The incidence of pre-engraftment immune reaction did not differ between the MMF/CSP (41 %) and MMF/TAC (39 %, p = 1.00) groups; however, patients in the MMF/TAC group tended to have a lower incidence of grade II-IV acute GVHD than those in MMF/CSP group (28 vs 53 %, p = 0.11). Overall survival (OS) at 1 year was 43 and 60 % in MMF/CSP and MMF/TAC groups, respectively (p = 0.39). Progression-free survival, non-relapse mortality, and relapse rate were comparable between the two groups (p = 0.76, 0.59, and 0.88, respectively). In multivariate analyses, MMF/TAC GVHD prophylaxis was closely associated with improved OS, but not with incidence of engraftment and acute GVHD. These results suggest that more intensive GVHD prophylaxis with MMF/TAC decreased acute GVHD without affecting other clinical outcomes, resulting in improved OS after RIC-UCBT.

• Authors: Toshihiro Miyamoto, Shuichiro Takashima, Koji Kato, Ken Takase, Goichi Yoshimoto, Shuro Yoshida, Hideho Henzan, Koichi Osaki, Tomohiko Kamimura, Hiromi Iwasaki, Tetsuya Eto, Takanori Teshima, Koji Nagafuji, Koichi Akashi
• Journal: International journal of hematology (Int J Hematol) Vol. 105 Issue 1 Pg. 92-99 (Jan 2017) ISSN: 1865-3774 [Electronic] Japan
• PMID: 27686673 (Publication Type: Comparative Study, Journal Article)

Chemical References

• Antibiotics, Antineoplastic
• Immunosuppressive Agents
• Cyclosporine
• Mycophenolic Acid
• Tacrolimus

Topics

• Adult
• Aged
• Antibiotics, Antineoplastic (therapeutic use)
• Cyclosporine (therapeutic use)
• Disease-Free Survival
• Female
• Fetal Blood (transplantation)
• Graft vs Host Disease (prevention & control)
• Hematologic Neoplasms (therapy)
• Humans
• Immunosuppressive Agents (therapeutic use)
• Male
• Middle Aged
• Mycophenolic Acid (therapeutic use)
• Neoplasm Recurrence, Local (prevention & control)
• Tacrolimus (therapeutic use)
• Transplantation Conditioning (methods)
• Treatment Outcome