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

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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.

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Acknowledgments

We thank the medical and nursing staff working on the Fukuoka Blood and Marrow Transplantation Group for providing patients information. This work was supported, in part, by a Grant-in-Aid for Scientific Research (No. 16H05340 to T.M.) and Grant-in-Aid for Scientific Research on Innovative Areas “Stem Cell Aging and Disease” (No. 25115002 to T.M.).

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Authors and Affiliations

  1. Department of Medicine and Biosystemic Science, Kyushu University Graduate School of Medical Science, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan

    Toshihiro Miyamoto, Shuichiro Takashima, Koji Kato, Goichi Yoshimoto, Hiromi Iwasaki, Takanori Teshima & Koichi Akashi

  2. Department of Hematology, National Kyushu Medical Center, Fukuoka, Japan

    Ken Takase & Hiromi Iwasaki

  3. Department of Hematology, Hamanomachi Hospital, Fukuoka, Japan

    Ken Takase, Shuro Yoshida, Hideho Henzan & Tetsuya Eto

  4. Department of Hematology, Kurume University Hospital, Kurume, Japan

    Koichi Osaki & Koji Nagafuji

  5. Department of Hematology, Harasanshin Hospital, Fukuoka, Japan

    Tomohiko Kamimura

  6. Department of Hematology, Hokkaido University Hospital, Sapporo, Japan

    Takanori Teshima

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  1. Toshihiro Miyamoto
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Miyamoto, T., Takashima, S., Kato, K. et al. Comparison of cyclosporine and tacrolimus combined with mycophenolate mofetil in prophylaxis for graft-versus-host disease after reduced-intensity umbilical cord blood transplantation. Int J Hematol 105, 92–99 (2017). https://doi.org/10.1007/s12185-016-2093-0

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