Tacrolimus for prevention of graft-versus-host disease after mismatched unrelated donor cord blood transplantation.
Ten children with hematologic malignancies or a storage disease underwent transplantation using cord blood cells from an unrelated donor mismatched for 1 (n = 7) or 2 (n = 3) HLA antigens. The median total nucleated cell dose was 4.0 (range, 2.2-7.1) x 10(7)/kg. GVHD prophylaxis consisted of tacrolimus dose-adjusted to maintain a whole blood level of 5-15 ng/ml with or without methotrexate 5 mg/m2 i.v. on days 1, 3, 6 and 11. Corticosteroids were not administered prophylactically. Median follow-up is 12 months (range, 5-28 months). One patient had autologous recovery and subsequently relapsed 153 days post transplant. For the remainder of the patients, the median time to an ANC >0.5 x 10(9)/l was 21 days (range, 19-38 days), and the median time to platelets >20 x 10(9)/l was 39 days (range, 21-97 days). The actuarial risk of grade 2 GVHD was 77% (95% CI, 49-100%), and no patient had grades 3-4 GVHD. Two patients developed chronic GVHD. The survival rate is 90% (95% CI, 81-100%). The combination of tacrolimus and minidose methotrexate is active for the prevention of severe but not moderate acute GVHD after mismatched unrelated donor cord blood transplantation.
Department of Blood and Marrow Transplantation, The University of Texas MD Anderson Cancer Center, Houston, USA.
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D
Przepiorka
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Petropoulos
C A
CA
Mullen
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M
Danielson
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Mattewada
K W
KW
Chan
D000964:Antimetabolites, Antineoplastic / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D005260:Female; D005312:Fetal Blood; D006086:Graft vs Host Disease / Q000517:prevention & control*; D019337:Hematologic Neoplasms / Q000628:therapy; D018380:Hematopoietic Stem Cell Transplantation; D006650:Histocompatibility Testing; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007223:Infant; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use; D016559:Tacrolimus / Q000627:therapeutic use*; D014019:Tissue Donors; D019172:Transplantation Conditioning
D000964:Antimetabolites, Antineoplastic; D007166:Immunosuppressive Agents; D016559:Tacrolimus; D008727:Methotrexate