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01-11-2019 | Graft-Versus-Host Disease | Original Article

Comparison of calcineurin inhibitors in combination with conventional methotrexate, reduced methotrexate, or mycophenolate mofetil for prophylaxis of graft-versus-host disease after umbilical cord blood transplantation

Authors: Shuro Yoshida, Yuju Ohno, Koji Nagafuji, Goichi Yoshimoto, Takeshi Sugio, Tomohiko Kamimura, Takanori Ohta, Ken Takase, Hideho Henzan, Tsuyoshi Muta, Hiromi Iwasaki, Ryosuke Ogawa, Tetsuya Eto, Koichi Akashi, Toshihiro Miyamoto

Published in: Annals of Hematology | Issue 11/2019

Abstract

Umbilical cord blood transplantation (UCBT) is a curative treatment for hematological malignancies. However, appropriate prophylaxis against graft-versus-host disease (GVHD), aimed at obtaining rapid and stable engraftment and avoiding toxicity, remains controversial in UCBT. We retrospectively compared outcomes in 409 patients who received calcineurin inhibitors (CIs) plus conventional-dose methotrexate (conv-MTX/CIs, n = 77; methotrexate, 10 mg/m² on day 1, 7 mg/m² on days 3 and 6) with those who received CIs plus reduced-dose methotrexate (reduced-MTX/CIs, n = 209; methotrexate, 5 mg/m² or 5 mg/body on days 1, 3, and 6) or CIs with mycophenolate mofetil (MMF/CIs, n = 123) for GVHD prophylaxis after UCBT. The cumulative incidence of neutrophil engraftment was significantly higher in the reduced-MTX/CI (82.3%) and MMF/CI (86.6%) groups than the conv-MTX/CI (71.4%) group (p = 0.014), although there were no differences in platelet recovery or infectious complications among the three groups. The incidence and severity of GVHD were comparable among the three groups, and there were no significant differences in transplantation-related mortality among the three groups. In conclusion, GVHD prophylaxis with reduced-dose methotrexate and MMF was closely associated with high incidence of neutrophil engraftment without an effect on the incidence and severity of GVHD, which was compared to GVHD prophylaxis with conventional-dose methotrexate.

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Title: Comparison of calcineurin inhibitors in combination with conventional methotrexate, reduced methotrexate, or mycophenolate mofetil for prophylaxis of graft-versus-host disease after umbilical cord blood transplantation
Authors: Shuro Yoshida
Yuju Ohno
Koji Nagafuji
Goichi Yoshimoto
Takeshi Sugio
Tomohiko Kamimura
Takanori Ohta
Ken Takase
Hideho Henzan
Tsuyoshi Muta
Hiromi Iwasaki
Ryosuke Ogawa
Tetsuya Eto
Koichi Akashi
Toshihiro Miyamoto
Publication date: 01-11-2019
Publisher: Springer Berlin Heidelberg
Keywords: Graft-Versus-Host Disease
Methotrexate
Methotrexate
Graft-Versus-Host Disease
Calcineurin Inhibitors
Mycophenolate Mofetil
Published in: Annals of Hematology / Issue 11/2019
Print ISSN: 0939-5555
Electronic ISSN: 1432-0584
DOI: https://doi.org/10.1007/s00277-019-03801-z

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Comparison of calcineurin inhibitors in combination with conventional methotrexate, reduced methotrexate, or mycophenolate mofetil for prophylaxis of graft-versus-host disease after umbilical cord blood transplantation

Abstract

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