title: Extended mycophenolate mofetil and shortened cyclosporine failed to reduce graft-versus-host disease after unrelated hematopoietic cell transplantation with nonmyeloablative conditioning.
abstract: We previously reported data from 103 patients with hematologic malignancies (median age 54 years) who received peripheral blood stem cell (PBSC) grafts from HLA-matched unrelated donors after nonmyeloablative conditioning and were given postgrafting immunosuppression consisting of mycophenolate mofetil (MMF; administered from day 0 until day +40 with taper through day +96) and cyclosporine (CSP; given from day -3 to day +100, with taper through day 180) (historical patients). The incidences of grade II-IV acute and extensive chronic graft-versus-host disease (aGVHD, cGVHD) were 52% and 49%, respectively, and the 1-year probabilities of relapse, nonrelapse mortality (NRM), and progression-free survival (PFS) were 26%, 18%, and 56%, respectively. Here, we treated 71 patients with hematologic malignancies (median age 56 years) with unrelated PBSC grafts and investigated whether postgrafting immunosuppression with an extended course of MMF, given at full dosing until day +150 and then tapered through day +180, and a shortened course of CSP, through day +80, would promote tolerance induction and reduce the incidence of GVHD (current patients). We observed 77% grade II-IV aGVHD and 45% extensive cGVHD (P=.03, and P=.43, respectively, in current compared to historical patients). The 1-year probabilities of relapse, NRM, and PFS were 23%, 29%, and 47%, respectively (P=.89, P=.02, and P=.08 compared to the historical patients). We conclude that postgrafting immunosuppression with extended MMF and shortened CSP failed to decrease the incidence of GVHD among unrelated PBSC recipients given nonmyeloablative conditioning.
authors: University of Liège, Liège, Belgium.
authors: Frédéric
authors: F
authors: Baron
authors: Brenda M
authors: BM
authors: Sandmaier
authors: Barry E
authors: BE
authors: Storer
authors: Michael B
authors: MB
authors: Maris
authors: Amelia A
authors: AA
authors: Langston
authors: Thoralf
authors: T
authors: Lange
authors: Effie
authors: E
authors: Petersdorf
authors: Wolfgang
authors: W
authors: Bethge
authors: Richard T
authors: RT
authors: Maziarz
authors: Peter A
authors: PA
authors: McSweeney
authors: Michael A
authors: MA
authors: Pulsipher
authors: James C
authors: JC
authors: Wade
authors: Thomas R
authors: TR
authors: Chauncey
authors: Judith A
authors: JA
authors: Shizuru
authors: Mohamed L
authors: ML
authors: Sorror
authors: Ann E
authors: AE
authors: Woolfrey
authors: David G
authors: DG
authors: Maloney
authors: Rainer
authors: R
authors: Storb
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D016572:Cyclosporine / Q000008:administration & dosage*; D005260:Female; D006086:Graft vs Host Disease / Q000517:prevention & control*; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000008:administration & dosage / Q000031:analogs & derivatives*; D019172:Transplantation Conditioning / Q000379:methods*; D017211:Treatment Failure
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D007166:Immunosuppressive Agents; D016572:Cyclosporine; D009173:Mycophenolic Acid
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