title: Mycophenolate mofetil vs. methotrexate for the prevention of graft-versus-host-disease--systematic review and meta-analysis.
abstract: We performed a systematic review and meta-analysis of all trials comparing MMF and methotrexate as GVHD prophylaxis. Our search yielded 11 studies; 3 were randomized-control trials (RCTs). While the incidence of grades 2-4 acute GVHD was comparable, the incidence of grades 3 and 4 acute GVHD was higher in patients given MMF (RR 1.61; 95% CI 1.18-2.30). Incidence of mucositis was lower (RR 0.35; 95% CI 0.25-0.49) and time to engraftment was shorter (mean difference (-3.6); 95% CI -5.5 to -1.7) in patients given MMF. All other analyzed transplantation outcomes were comparable. We conclude that MMF, compared to methotrexate, is associated with increased severity of acute GVHD. Robustness of these results is hampered by the small number of RCTs.
authors.affiliation: Bone Marrow Transplantation Unit, Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Beilinson Hospital, Petah-Tiqva, Israel; Sackler School of Medicine, Tel Aviv University, Ramat Aviv, Israel. Electronic address: ronram73@gmail.com.
authors.forename: Ron
authors.initials: R
authors.lastname: Ram
authors.affiliation: Bone Marrow Transplantation Unit, Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Beilinson Hospital, Petah-Tiqva, Israel; Sackler School of Medicine, Tel Aviv University, Ramat Aviv, Israel.
authors.forename: Moshe
authors.initials: M
authors.lastname: Yeshurun
authors.affiliation: Bone Marrow Transplantation Unit, Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Beilinson Hospital, Petah-Tiqva, Israel; Sackler School of Medicine, Tel Aviv University, Ramat Aviv, Israel.
authors.forename: Liat
authors.initials: L
authors.lastname: Vidal
authors.affiliation: Bone Marrow Transplantation Unit, Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Beilinson Hospital, Petah-Tiqva, Israel; Sackler School of Medicine, Tel Aviv University, Ramat Aviv, Israel.
authors.forename: Ofer
authors.initials: O
authors.lastname: Shpilberg
authors.affiliation: Bone Marrow Transplantation Unit, Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Beilinson Hospital, Petah-Tiqva, Israel; Sackler School of Medicine, Tel Aviv University, Ramat Aviv, Israel.
authors.forename: Anat
authors.initials: A
authors.lastname: Gafter-Gvili
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002986:Clinical Trials as Topic; D006086:Graft vs Host Disease / Q000517:prevention & control*; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008727:Methotrexate / Q000627:therapeutic use*; D008875:Middle Aged; D052016:Mucositis / Q000517:prevention & control; D009173:Mycophenolic Acid / Q000031:analogs & derivatives* / Q000627:therapeutic use; D012720:Severity of Illness Index; D019172:Transplantation Conditioning; D014184:Transplantation, Homologous
chemical_list: D007166:Immunosuppressive Agents; D009173:Mycophenolic Acid; D008727:Methotrexate
keywords: Allogeneic transplantation; Graft-versus-host disease; Methotrexate; Mycopheolate