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International Journal of Hematology
Published in: International Journal of Hematology 2/2021

01-08-2021 | Graft-Versus-Host Disease | Original Article

Prognostic impact of the dosage of methotrexate combined with tacrolimus for graft-versus-host disease prophylaxis after cord blood transplantation

Authors: Miwa Adachi, Daisuke Yokota, Hiroya Hirata, Katsumi Koyauchi, Satoshi Dohtan, Shinichiro Oka, Nami Sakamoto, Masamitsu Takaba, Tomonari Takemura, Yasuyuki Nagata, Kensuke Naito, Takaaki Ono

Published in: International Journal of Hematology | Issue 2/2021

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Abstract

The optimal dosage of methotrexate (MTX) for graft-versus-host disease (GVHD) prophylaxis after cord blood transplantation (CBT) has not been well elucidated. Therefore, we conducted a retrospective study comparing a mini-MTX group (5 mg/m2 on day 1, 3 and 6) to a short-MTX group (10 mg/m2 on day 1 and 7 mg/m2 on day 3 and 6) after CBT. Sixty-three patients were classified as the mini-MTX group and 20 as the short-MTX group. The median time and cumulative incidence of neutrophil engraftment did not vary between the two groups. The cumulative incidence of grade 2–4 and grade 3–4 acute GVHD was similar in both groups. Overall survival in the mini-MTX group was significantly lower than in the short-MTX group (46.9% vs. 88.7% at 1 year, p < 0.01), contributing to higher non-relapse mortality (NRM) in the mini-MTX group (32.0% vs. 5.0% at 1 year, p = 0.02). In multivariate analysis, the mini-MTX regimen was the most powerful prognostic factor for OS (hazard ratio 4.11; p = 0.03). Although the reduced dosage of MTX had no effect on neutrophil engraftment, increased NRM due to higher incidence of infection, graft failure, and severe acute GVHD resulted in a lower survival rate in the mini-MTX group after CBT.
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Metadata
Title
Prognostic impact of the dosage of methotrexate combined with tacrolimus for graft-versus-host disease prophylaxis after cord blood transplantation
Authors
Miwa Adachi
Daisuke Yokota
Hiroya Hirata
Katsumi Koyauchi
Satoshi Dohtan
Shinichiro Oka
Nami Sakamoto
Masamitsu Takaba
Tomonari Takemura
Yasuyuki Nagata
Kensuke Naito
Takaaki Ono
Publication date
01-08-2021
Publisher
Springer Singapore
Published in
International Journal of Hematology / Issue 2/2021
Print ISSN: 0925-5710
Electronic ISSN: 1865-3774
DOI
https://doi.org/10.1007/s12185-021-03161-3

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