Unknown

Dataset Information

0

Inferior Outcomes with Cyclosporine and Mycophenolate Mofetil after Myeloablative Allogeneic Hematopoietic Cell Transplantation.

ABSTRACT: Combination therapy with a calcineurin inhibitor (CNI), such as cyclosporine (CSA) or tacrolimus (Tac), and methotrexate (MTX) or mycophenolate mofetil (MMF) is a widely used approach to graft-versus-host disease (GVHD) prevention. Data on the comparative effectiveness of MMF compared with MTX are limited and conflicting, however. We analyzed data from the Center for International Blood and Marrow Transplant Research for adult patients undergoing first myeloablative hematopoietic cell transplantation (HCT) from an HLA-identical matched related donor (MRD; n?=?3979) or matched unrelated donor (URD; n?=?4163) using CSA+MMF, CSA+MTX, Tac+MMF, or Tac+MTX for GVHD prevention between 2000 and 2013. Within the MRD cohort, 2252 patients received CSA+MTX, 1391 received Tac+MTX, 114 received CSA+MMF, and 222 received Tac+MMF. Recipients of CSA+MMF had a higher incidence of acute GVHD grade II-IV (hazard ratio [HR], 1.65; 95% confidence interval [CI], 1.24 to 2.20; P < .001) and grade III-IV (HR, 1.92; 95% CI, 1.31 to 2.83; P < .001) compared with Tac+MTX. The use of CSA+MMF was also associated with inferior overall survival (OS) (HR, 2.31; 95% CI, 1.73 to 3.09; P < .001) due to higher transplantation-related mortality (TRM) (HR, 4.03; 95% CI, 2.61 to 6.23; P < .001) compared with Tac+MTX. Within the URD cohort, 974 patients received CSA+MTX, 2697 received Tac+MTX, 68 received CSA+MMF, and 424 received Tac+MMF. CSA+MMF was again significantly associated with a higher incidence of grade III-IV acute GVHD (HR, 2.31; 95% CI, 1.57 to 3.42; P <0001), worse OS (HR, 2.36; 95% CI, 1.67 to 3.35; P < .001), and higher TRM (HR, 3.09; 95% CI, 2.00 to 4.77; P < .001), compared with Tac+MTX and other regimens. Thus, this large retrospective comparison of MMF versus MTX in combination with CSA or Tac demonstrates significantly worse GVHD and survival outcomes with CSA+MMF compared with Tac+MTX.

SUBMITTER: Hamilton BK 

PROVIDER: S-EPMC7039394 | biostudies-literature | 2019 Sep

REPOSITORIES: biostudies-literature

Json Xml
altmetric image

Publications

Inferior Outcomes with Cyclosporine and Mycophenolate Mofetil after Myeloablative Allogeneic Hematopoietic Cell Transplantation.

Hamilton Betty K BK   Liu Ying Y   Hemmer Michael T MT   Majhail Navneet N   Ringden Olle O   Kim Dennis D   Costa Luciano L   Stuart Robert R   Alousi Amin A   Pidala Joseph A JA   Couriel Daniel R DR   Aljurf Mahmoud M   Antin Joseph H JH   Bredeson Christopher C   Cahn Jean-Yves JY   Cairo Mitchell M   Choi Sung Won SW   Dandoy Christopher C   Gale Robert Peter RP   Gergis Usama U   Hematti Peiman P   Inamoto Yoshihiro Y   Kamble Rammurti T RT   MacMillan Margaret M   Marks David I DI   Nemecek Eneida E   Nishihori Taiga T   Saad Ayman A   Savani Bipin N BN   Schriber Jeff J   Seo Sachiko S   Socié Gérard G   Teshima Takanori T   Verdonck Leo F LF   Waller Edmund K EK   Wirk Mona M   Spellman Stephen R SR   Arora Mukta M   Chhabra Saurabh S  

Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation 20190531 9

Combination therapy with a calcineurin inhibitor (CNI), such as cyclosporine (CSA) or tacrolimus (Tac), and methotrexate (MTX) or mycophenolate mofetil (MMF) is a widely used approach to graft-versus-host disease (GVHD) prevention. Data on the comparative effectiveness of MMF compared with MTX are limited and conflicting, however. We analyzed data from the Center for International Blood and Marrow Transplant Research for adult patients undergoing first myeloablative hematopoietic cell transplant  ...[more]

Similar Datasets

Unknown Weight-based mycophenolate mofetil dosing predicts acute GVHD and relapse after allogeneic hematopoietic cell transplantation.
| S-EPMC8711731 | biostudies-literature
Unknown Cyclosporine A trough concentrations are associated with acute GvHD after non-myeloablative allogeneic hematopoietic cell transplantation.
| S-EPMC6428294 | biostudies-literature
Unknown Plerixafor (a CXCR4 antagonist) following myeloablative allogeneic hematopoietic stem cell transplantation enhances hematopoietic recovery.
| S-EPMC4989381 | biostudies-literature
Unknown Primary graft failure after myeloablative allogeneic hematopoietic cell transplantation for hematologic malignancies.
| S-EPMC4527886 | biostudies-literature
Unknown Myeloablative vs reduced-intensity conditioning allogeneic hematopoietic cell transplantation for chronic myeloid leukemia.
| S-EPMC6234373 | biostudies-literature
Unknown Allogeneic Hematopoietic Stem Cell Transplantation with Myeloablative Conditioning Is Associated with Favorable Outcomes in Mixed Phenotype Acute Leukemia.
| S-EPMC5682215 | biostudies-literature
Unknown Cytopenia and leukocyte recovery shape cytokine fluctuations after myeloablative allogeneic hematopoietic stem cell transplantation.
| S-EPMC3366652 | biostudies-literature
Unknown Long-term Outcomes with Nonmyeloablative HLA-Identical Related Hematopoietic Cell Transplantation Using Tacrolimus and Mycophenolate Mofetil for Graft-versus-Host Disease Prophylaxis.
| S-EPMC8035484 | biostudies-literature
Unknown Pharmacokinetic and pharmacodynamic analysis of inosine monophosphate dehydrogenase activity in hematopoietic cell transplantation recipients treated with mycophenolate mofetil.
| S-EPMC4099316 | biostudies-literature
Unknown Engraftment syndrome after allogeneic hematopoietic cell transplantation predicts poor outcomes.
| S-EPMC4142041 | biostudies-literature