Comparative Analysis of Calcineurin Inhibitor-Based Methotrexate and Mycophenolate Mofetil-Containing Regimens for Prevention of Graft-versus-Host Disease after Reduced-Intensity Conditioning Allogeneic Transplantation

被引：35

作者：

Chhabra, Saurabh ^{[1
]}

Liu, Ying ^{[2
,3
]}

Hemmer, Michael T. ^{[2
]}

Costa, Luciano ^{[4
]}

Pidala, Joseph A. ^{[5
]}

Courie, Daniel R. ^{[6
]}

Alousi, Amin M. ^{[7
]}

Majhai, Navneet S. ^{[8
]}

Stuart, Robert K. ^{[9
]}

Kim, Dennis ^{[10
]}

Ringden, Olle ^{[11
]}

Urbano-Ispizua, Alvaro ^{[12
]}

Saad, Ayman ^{[4
]}

Savani, Bipin N. ^{[13
]}

Cooper, Brenda ^{[14
]}

Marks, David I. ^{[15
]}

Socie, Gerard ^{[16
]}

Schouten, Harry C. ^{[17
]}

Schoemans, Helene ^{[18
]}

Abdel-Azim, Hisham ^{[19
]}

Yared, Jean ^{[20
]}

Cahn, Jean-Yves ^{[21
]}

Wagner, John ^{[22
]}

Antin, Joseph H. ^{[23
]}

Verdonck, Leo F. ^{[24
]}

Lehmann, Leslie ^{[23
]}

Aljurf, Mahmoud D. ^{[25
]}

MacMillan, Margaret L. ^{[26
]}

Litzow, Mark R. ^{[27
,28
]}

Solh, Melhem M. ^{[29
]}

Qayed, Muna ^{[30
]}

Hematti, Peiman ^{[31
]}

Kamble, Rammurti T. ^{[32
]}

Vij, Ravi ^{[33
]}

Hayashi, Roberti ^{[34
]}

Gale, Robert P. ^{[35
]}

Martino, Rodrigo ^{[36
]}

Seo, Sachiko ^{[37
]}

Hashmi, Shahrukh K. ^{[25
,27
,28
]}

Nishihori, Taiga ^{[5
]}

Teshima, Takanori ^{[38
]}

Gergis, Usama ^{[39
]}

Inamoto, Yoshihiro ^{[40
]}

Spellman, Stephen R. ^{[41
]}

Arora, Mukta ^{[42
]}

Hamilton, Betty K. ^{[8
]}

机构：

[1] Med Coll Wisconsin, Dept Med, Div Hematol Oncol, Milwaukee, WI 53226 USA

[2] Med Coll Wisconsin, Dept Med, Ctr Int Blood & Marrow Transplant Res, Milwaukee, WI 53226 USA

[3] Med Coll Wisconsin, Dept Biostat, Inst Hlth & Soc, Milwaukee, WI 53226 USA

[4] Univ Alabama Birmingham, Dept Med, Div Hematol Oncol, Birmingham, AL 35294 USA

[5] H Lee Moffitt Canc Ctr & Res Inst, Dept Blood & Marrow Transplantat, Tampa, FL USA

[6] Utah Blood & Marrow Transplant Program, Div Hematol & Hematol Malignancies, Salt Lake City, UT USA

[7] Univ Texas MD Anderson Canc Ctr, Div Canc Med, Dept Stem Cell Transplantat, Houston, TX 77030 USA

[8] Cleveland Clin, Taussig Canc Inst, Blood & Marrow Transplant Program, Cleveland, OH 44106 USA

[9] Med Univ South Carolina, Dept Med, Div Hematol Oncol, Charleston, SC 29425 USA

[10] Princess Margaret Canc Ctr, Dept Med Oncol & Hematol, Toronto, ON, Canada

[11] Karolinska Inst, Dept Lab Med, Div Therapeut Immunol, Stockholm, Sweden

[12] Univ Barcelona, Hosp Clin, Inst Res Josep Carreras, IDIBAPS,Dept Hematol, Barcelona, Spain

[13] Vanderbilt Univ, Med Ctr, Dept Med, Div Hematol Oncol, Nashville, TN USA

[14] Univ Hosp, Case Med Ctr, Dept Med Hematol & Oncol, Cleveland, OH USA

[15] Univ Hosp Bristol NHS Trust, Adult Bone Marrow Transplant, Bristol, Avon, England

[16] Hop St Louis, Dept Hematol, Paris, France

[17] Acad Ziekenhuis, Dept Hematol, Maastricht, Netherlands

[18] Univ Hosp Leuven, Dept Pediat 26, Dept Hematol, Leuven, Belgium

[19] Univ Southern Calif, Keck Sch Med, Childrens Hosp Los Angeles, Div Hematol Oncol & Blood & Marrow Transplantat, Los Angeles, CA 90033 USA

[20] Univ Maryland, Greenebaum Canc Ctr, Div Hematol Oncol, Dept Med,Blood & Marrow Transplantat Program, Baltimore, MD 21201 USA

[21] CHU Grenoble Alpes, Dept Hematol, Grenoble, France

[22] Thomas Jefferson Univ, Dept Med Oncol, Philadelphia, PA 19107 USA

[23] Dana Farber Canc Inst, Dept Med Oncol, Div Hematol Malignancies, Boston, MA 02115 USA

[24] Isola Clin, Dept Hematol Oncol, Zwolle, Netherlands

[25] King Faisal Specialist Hosp Ctr & Res, Dept Oncol, Riyadh, Saudi Arabia

[26] Univ Minnesota, Blood & Marrow Transplant Program, Minneapolis, MN USA

[27] Mayo Clin, Div Hematol, Rochester, MN USA

[28] Mayo Clin, Transplant Ctr, Rochester, MN USA

[29] Northside Hosp, Blood & Marrow Transplant Grp Georgia, Atlanta, GA USA

[30] Emory Univ, Sch Med, Dept Pediat, Atlanta, GA USA

[31] Univ Wisconsin Hosp & Clin, Dept Med, Div Hematol Oncol Bone Marrow Transplantat, Madison, WI 53792 USA

[32] Baylor Coll Med, Ctr Cell & Gene Therapy, Div Hematol & Oncol, Houston, TX 77030 USA

[33] Washington Univ, Sch Med, Div Hematol & Oncol, St Louis, MO USA

[34] Washington Univ, Sch Med St Louis, Dept Pediat, Div Pediat Hematol Oncol, St Louis, MO USA

[35] Imperial Coll London, Dept Med, Div Expt Med, Hematol Res Ctr, London, England

[36] Hosp Santa Creu & Sant Pau, Div Clin Hematol, Barcelona, Spain

[37] Natl Canc Res Ctr East, Dept Hematol & Oncol, Chiba, Japan

[38] Kyushu Univ Hosp, Dept Hematol, Sapporo, Hokkaido, Japan

[39] New York Presbyterian Hosp, Weill Cornell Med Ctr, Dept Med Oncol, Hematolg Malignancies & Bone Marrow Transplant, New York, NY USA

[40] Natl Canc Ctr, Hematopoiet Stem Cell Transplantat, Tokyo, Japan

[41] Ctr Int Blood & Marrow Transplant Res, Natl Marrow Donor Program Be Match, Minneapolis, MN USA

[42] Univ Minnesota, Med Ctr, Dept Med, Div Hematol Oncol & Transplantat, Minneapolis, MN 55455 USA

来源：

BIOLOGY OF BLOOD AND MARROW TRANSPLANTATION | 2019年 / 25卷 / 01期

关键词：

Calcineurin inhibitor Tacrolimus; Cyclosporine; Methotrexate; Mycophenolate mofetil; Graft-versus-host disease prophylaxis; Reduced-intensity conditioning; Allogeneic hematopoietic cell transplantation; STEM-CELL TRANSPLANTATION; BONE-MARROW; COMPARING METHOTREXATE; GVHD PROPHYLAXIS; CYCLOSPORINE; BLOOD; TACROLIMUS; TRIAL;

D O I：

10.1016/j.bbmt.2018.08.018

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

The combination of a calcineurin inhibitor (CNI) such as tacrolimus (TAC) or cyclosporine (CYSP) with methotrexate (MTX) or with mycophenolate mofetil (MMF) has been commonly used for graft-versus-host disease (GVHD) prophylaxis after reduced-intensity conditioning (RIC) allogeneic hematopoietic cell transplantation (alloHCT), but there are limited data comparing efficacy of the 2 regimens. We evaluated 1564 adult patients who underwent RIC alloHCT for acute myelogenous leukemia (AML) and acute lymphoblastic leukemia (ALL), chronic myelogenous leukemia (CML), and myelodysplastic syndrome (MDS) from 2000 to 2013 using HLA-identical sibling (matched related donor [MRD]) or unrelated donor (URD) peripheral blood graft and received CYSP or TAC with MTX or MMF for GVHD prophylaxis. Primary outcomes of the study were acute and chronic GVHD and overall survival (OS). The study divided the patient population into 4 cohorts based on regimen: MMF-TAC, MMF-CYSP, MTX-TAC, and MTX-CYSP. In the URD group, MMF-CYSP was associated with increased risk of grade II to IV acute GVHD (relative risk [RR], 1.78; P < .001) and grade Ill to IV acute GVHD (RR, 1.93; P = .006) compared with MTX-TAC. In the URD group, use of MMF-TAC (versus MTX-TAC) lead to higher nonrelapse mortality. (hazard ratio, 1.48; P = .008). In either group, no there was no difference in chronic GVHD, disease-free survival, and OS among the GVHD prophylaxis regimens. For RIC alloHCT using MRD, there are no differences in outcomes based on GVHD prophylaxis. However, with URD RIC alloHCT, MMF-CYSP was inferior to MTX-based regimens for acute GVHD prevention, but all the regimens were equivalent in terms of chronic GVHD and OS. Prospective studies, targeting URD recipients are needed to confirm these results. (C) 2018 American Society for Blood and Marrow Transplantation.

引用

页码：73 / 85

页数：13

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