Combination of CsA, MTX and low-dose, short-course mycophenolate mofetil for GVHD prophylaxis.
In an effort to reduce the incidence and severity of acute GVHD (aGVHD), we have developed a new prophylaxis regimen combining cyclosporine and MTX with a short 30-day course of low-dose (500 mg per day) mycophenolate mofetil. This regimen was studied prospectively 100 patients undergoing HLA-matched and 1-antigen-mismatched allogeneic peripheral blood SCT from related donors. The cumulative incidence of aGVHD was 16% (grades II-IV (9.5%) and grades III-IV (1%)). The cumulative incidence of chronic GVHD (cGVHD) was 53% with 28% extensive cGVHD. The cumulative incidence of transplant-related mortality at 100 days and 3 years were 6 and 13%. The estimated probabilities of disease-free survival at 3 years in standard- and high-risk patients were 77 and 30%, respectively (P<0.0001). The estimated probabilities of overall survival at 3 years in standard- and high-risk patients were 77 and 37%, respectively (P<0.0001). These data show a substantial decrease in the risk of developing aGVHD without an increase in relapse or any adverse impact on survival in standard-risk patients.
Lai
Y
Y
Department of Hematology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China. laiyongrong@hotmail.com
Ma
J
J
Schwarzenberger
P
P
Li
W
W
Cai
Z
Z
Zhou
J
J
Peng
Z
Z
Yang
J
J
Luo
L
L
Luo
J
J
Deng
D
D
Li
Q
Q
Zhou
Y
Y
Liang
J
J
D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D016572:Cyclosporine / Q000009:adverse effects / Q000627:therapeutic use*; D018572:Disease-Free Survival; D005260:Female; D006086:Graft vs Host Disease / Q000276:immunology / Q000517:prevention & control*; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D008727:Methotrexate / Q000009:adverse effects / Q000627:therapeutic use*; D008875:Middle Aged; D052016:Mucositis; D009173:Mycophenolic Acid / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D011446:Prospective Studies; D019172:Transplantation Conditioning; D055815:Young Adult
D007166:Immunosuppressive Agents; D016572:Cyclosporine; D009173:Mycophenolic Acid; D008727:Methotrexate