title: Mycophenolate and tacrolimus for graft-versus-host disease prophylaxis for elderly after cord blood transplantation: a matched pair comparison with tacrolimus alone.
abstract: BACKGROUND
  The optimal graft-versus-host disease (GVHD) prophylaxis after umbilical cord blood transplantation has not been established. Our previous observation using single calcineurin inhibitors revealed a high incidence and severity of early immune-mediated complications, especially for older patients or those with poor performance status.
  
  
  METHODS
  We conducted a single institute pilot study assessing the safety and effectiveness of mycophenolate mofetil (MMF) and tacrolimus (FK) combination as a GVHD prophylaxis for 29 patients (FK+MMF), and the results were compared with matched-pairs extracted from our historical database who received FK alone as GVHD prophylaxis (control).
  
  
  RESULTS
  FK+MMF group showed superior engraftment rate compared with control group (cumulative incidence until day 60 posttransplant; 90%±0% vs. 69%±1%, P=0.02). A cumulative incidence of severe type preengraftment immune reactions was significantly decreased in FK+MMF group (16%±1%) compared with that of control group (52%±2%, P=0.03), and, remarkably, there was no nonrelapse mortality (NRM) observed up to day 30 posttransplant in FK+MMF group, whereas 21%±1% of NRM was observed in the control group. However, the incidences of acute and chronic GVHD, estimated overall and progression-free survivals were comparable between two groups.
  
  
  CONCLUSIONS
  MMF and FK in combination was well tolerated and decreased early NRM possibly by better control of preengraftment immune reactions. Subsequent NRM or disease progression needs to be overcome to further improve survival.
authors.affiliation: Department of Hematology, Toranomon Hospital, Minato-Ku, Tokyo, Japan. nuchida@toranomon.gr.jp
authors.forename: Naoyuki
authors.initials: N
authors.lastname: Uchida
authors.forename: Atsushi
authors.initials: A
authors.lastname: Wake
authors.forename: Nobuaki
authors.initials: N
authors.lastname: Nakano
authors.forename: Kazuya
authors.initials: K
authors.lastname: Ishiwata
authors.forename: Shinsuke
authors.initials: S
authors.lastname: Takagi
authors.forename: Masanori
authors.initials: M
authors.lastname: Tsuji
authors.forename: Hisashi
authors.initials: H
authors.lastname: Yamamoto
authors.forename: Daisuke
authors.initials: D
authors.lastname: Kato
authors.forename: Naofumi
authors.initials: N
authors.lastname: Matsuno
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Masuoka
authors.forename: Hideki
authors.initials: H
authors.lastname: Araoka
authors.forename: Yuki
authors.initials: Y
authors.lastname: Asano-Mori
authors.forename: Koji
authors.initials: K
authors.lastname: Izutsu
authors.forename: Shigeyoshi
authors.initials: S
authors.lastname: Makino
authors.forename: Akiko
authors.initials: A
authors.lastname: Yoneyama
authors.forename: Shuichi
authors.initials: S
authors.lastname: Taniguchi
mesh_terms: D000208:Acute Disease; D000367:Age Factors; D000368:Aged; D002908:Chronic Disease; D036101:Cord Blood Stem Cell Transplantation / Q000009:adverse effects* / Q000401:mortality; D016208:Databases, Factual / Q000706:statistics & numerical data; D018450:Disease Progression; D018572:Disease-Free Survival; D005260:Female; D006086:Graft vs Host Disease / Q000401:mortality / Q000517:prevention & control*; D006402:Hematologic Diseases / Q000401:mortality / Q000628:therapy*; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage* / Q000009:adverse effects; D015994:Incidence; D008297:Male; D016555:Matched-Pair Analysis; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D010865:Pilot Projects; D016559:Tacrolimus / Q000008:administration & dosage* / Q000009:adverse effects
chemical_list: D007166:Immunosuppressive Agents; D009173:Mycophenolic Acid; D016559:Tacrolimus