title: Tacrolimus and methotrexate for the prophylaxis of graft-versus-host disease after unrelated donor cord blood transplantation for adult patients with hematologic malignancies.
abstract: Eighteen patients with hematologic malignancies underwent cord blood transplantation (CBT) from unrelated donors after being conditioned with myeloablative or reduced-intensity regimens, and received tacrolimus and methotrexate (15 mg/m(2) on day 1, 10 mg/m(2) on days 3 and 6) as graft-versus-host disease (GVHD) prophylaxis. The median number of nucleated cells in infused cord blood was 2.66 x 10(7)/kg (range 1.90 to 4.15 x 10(7)/kg). Engraftment was achieved in 16 of 18 patients. The median time to absolute neutrophil count >0.5 x 10(9)/L was 21.5 days (range 17 to 32), and the median time to platelet count >2.0 x 10(9)/L was 36 days (range 26 to 57). Of the 16 evaluable patients, five and eight had grades I and II acute GVHD, respectively, and none had grades III/IV acute GVHD. The cumulative incidence of grade II acute GVHD was 44.4%. Chronic GVHD occurred in 7 of 15 evaluable patients: limited type in three patients, extensive type in four patients. Of the 18 patients, 14 were alive and disease-free between 173 and 1514 days after CBT (median 746 days). The probability of disease-free survival at 2 years was 79.1%. These results, although in a retrospective study, suggested that tacrolimus and short-term methotrexate effectively prevented the occurrence of severe acute GVHD after unrelated CBT, and may contribute to a high survival rate.
authors.affiliation: Department of Medicine, Division of Hematology, Keio University School of Medicine, Shinjuku-ku, Tokyo 160-8582, Japan. tmori@sc.itc.keio.ac.jp
authors.forename: T
authors.initials: T
authors.lastname: Mori
authors.forename: Y
authors.initials: Y
authors.lastname: Aisa
authors.forename: T
authors.initials: T
authors.lastname: Nakazato
authors.forename: R
authors.initials: R
authors.lastname: Yamazaki
authors.forename: T
authors.initials: T
authors.lastname: Shimizu
authors.forename: A
authors.initials: A
authors.lastname: Mihara
authors.forename: A
authors.initials: A
authors.lastname: Yamane
authors.forename: Y
authors.initials: Y
authors.lastname: Ikeda
authors.forename: S
authors.initials: S
authors.lastname: Okamoto
mesh_terms: D000328:Adult; D036101:Cord Blood Stem Cell Transplantation / Q000009:adverse effects*; D018572:Disease-Free Survival; D005260:Female; D006086:Graft vs Host Disease / Q000517:prevention & control*; D019337:Hematologic Neoplasms / Q000628:therapy*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007938:Leukemia / Q000628:therapy; D007958:Leukocyte Count; D008223:Lymphoma / Q000628:therapy; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use*; D008875:Middle Aged; D009190:Myelodysplastic Syndromes / Q000628:therapy; D009504:Neutrophils; D011336:Probability; D016559:Tacrolimus / Q000627:therapeutic use*; D019172:Transplantation Conditioning
chemical_list: D007166:Immunosuppressive Agents; D016559:Tacrolimus; D008727:Methotrexate