title: Tacrolimus versus Cyclosporine after Hematopoietic Cell Transplantation for Acquired Aplastic Anemia.
abstract: Combinations of cyclosporine (CSP) with methotrexate (MTX) have been widely used for immunosuppression after allogeneic transplantation for acquired aplastic anemia. We compared outcomes with tacrolimus (TAC)+MTX versus CSP+MTX after transplantation from HLA-identical siblings (SIB) or unrelated donors (URD) in a retrospective cohort of 949 patients with severe aplastic anemia. Study endpoints included hematopoietic recovery, graft failure, acute graft-versus-host disease (GVHD), chronic GVHD, and mortality. TAC+MTX was used more frequently in older patients and, in recent years, in both SIB and URD groups. In multivariate analysis, TAC+MTX was associated with a lower risk of mortality in URD recipients and with slightly earlier absolute neutrophil count recovery in SIB recipients. Other outcomes did not differ statistically between the 2 regimens. No firm conclusions were reached regarding the relative merits of TAC+MTX versus CSP+MTX after hematopoietic cell transplantation for acquired aplastic anemia. Prospective studies would be needed to determine whether the use of TAC+MTX is associated with lower risk of mortality in URD recipients with acquired aplastic anemia.
authors.affiliation: Division of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan. Electronic address: yinamoto@ncc.go.jp.
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Inamoto
authors.affiliation: Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington.
authors.forename: Mary E D
authors.initials: ME
authors.lastname: Flowers
authors.affiliation: Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin; Division of Biostatistics, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: Tao
authors.initials: T
authors.lastname: Wang
authors.affiliation: Department of Hematology, Hospital Clinic, University of Barcelona, IDIBAPS and Institute of Research Josep Carreras, Barcelona, Spain.
authors.forename: Alvaro
authors.initials: A
authors.lastname: Urbano-Ispizua
authors.affiliation: Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: Michael T
authors.initials: MT
authors.lastname: Hemmer
authors.affiliation: Center for Hematologic Oncology, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.
authors.forename: Corey S
authors.initials: CS
authors.lastname: Cutler
authors.affiliation: Department of Medicine, University of Michigan, Ann Arbor, Michigan.
authors.forename: Daniel R
authors.initials: DR
authors.lastname: Couriel
authors.affiliation: Division of Cancer Medicine, Department of Stem Cell Transplantation, University of Texas M.D. Anderson Cancer Center, Houston, Texas.
authors.forename: Amin M
authors.initials: AM
authors.lastname: Alousi
authors.affiliation: Center for Hematologic Oncology, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.
authors.forename: Joseph H
authors.initials: JH
authors.lastname: Antin
authors.affiliation: Hematology Research Centre, Division of Experimental Medicine, Department of Medicine, Imperial College of London, London, United Kingdom.
authors.forename: Robert Peter
authors.initials: RP
authors.lastname: Gale
authors.affiliation: Blood and Marrow Transplant Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.
authors.forename: Vikas
authors.initials: V
authors.lastname: Gupta
authors.affiliation: Blood and Marrow Transplant Program, Cleveland Clinic Taussig Cancer Institute, Cleveland, Ohio.
authors.forename: Betty K
authors.initials: BK
authors.lastname: Hamilton
authors.affiliation: Department of Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida.
authors.forename: Mohamed A
authors.initials: MA
authors.lastname: Kharfan-Dabaja
authors.affiliation: Pediatric Bone Marrow Transplant, University Hospitals Bristol NHS Trust, Bristol, United Kingdom.
authors.forename: David I
authors.initials: DI
authors.lastname: Marks
authors.affiliation: Division of Therapeutic Immunology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden; Centre for Allogeneic Stem Cell Transplantation, Stockholm, Sweden.
authors.forename: Olle T H
authors.initials: OT
authors.lastname: Ringdén
authors.affiliation: Department of Hematology, Hospital Saint Louis, Paris, France.
authors.forename: Gérard
authors.initials: G
authors.lastname: Socié
authors.affiliation: Blood and Marrow Transplant Center, Florida Hospital Medical Group, Orlando, Florida.
authors.forename: Melhem M
authors.initials: MM
authors.lastname: Solh
authors.affiliation: Stem Cell Transplantation and Cellular Therapy Program, Banner MD Anderson Cancer Center, Gilbert, Arizona.
authors.forename: Görgün
authors.initials: G
authors.lastname: Akpek
authors.affiliation: Department of Pediatrics, New York Medical College, Valhalla, New York.
authors.forename: Mitchell S
authors.initials: MS
authors.lastname: Cairo
authors.affiliation: Division of Cell Therapy and Hematologica, Department of Medicine, Duke University Medical Center, Durham, North Carolina.
authors.forename: Nelson J
authors.initials: NJ
authors.lastname: Chao
authors.affiliation: Division of Pediatric Hematology/Oncology, Department of Pediatrics, Washington University School of Medicine in St. Louis, St. Louis, Missouri.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Hayashi
authors.affiliation: Department of Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida.
authors.forename: Taiga
authors.initials: T
authors.lastname: Nishihori
authors.affiliation: Department of Medicine, Abramson Cancer Center, University of Pennsylvania Medical Center, Philadelphia, Pennsylvania.
authors.forename: Ran
authors.initials: R
authors.lastname: Reshef
authors.affiliation: Division of Hematology/Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: Ayman
authors.initials: A
authors.lastname: Saad
authors.affiliation: Division of Hematology/Oncology, Department of Pediatrics, Mattel Children's Hospital at University of California Los Angeles, Los Angeles, California.
authors.forename: Ami
authors.initials: A
authors.lastname: Shah
authors.affiliation: Department of Hematology, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
authors.forename: Takanori
authors.initials: T
authors.lastname: Teshima
authors.affiliation: Leukemia Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.
authors.forename: Martin S
authors.initials: MS
authors.lastname: Tallman
authors.affiliation: Division of Bone Marrow Transplant, Seattle Cancer Care Alliance, Seattle, Washington.
authors.forename: Baldeep
authors.initials: B
authors.lastname: Wirk
authors.affiliation: Center for International Blood and Marrow Transplant Research, National Marrow Donor Program/Be The Match, Minneapolis, Minneapolis.
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Spellman
authors.affiliation: Division of Hematology, Oncology, Transplantation, Department of Medicine, University of Minnesota Medical Center, Minneapolis, Minnesota.
authors.forename: Mukta
authors.initials: M
authors.lastname: Arora
authors.affiliation: Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington.
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Martin
mesh_terms: D000367:Age Factors; D000741:Anemia, Aplastic / Q000628:therapy*; D016572:Cyclosporine / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005260:Female; D006085:Graft Survival; D006086:Graft vs Host Disease / Q000453:epidemiology / Q000517:prevention & control*; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D019520:Living Donors; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D016559:Tacrolimus / Q000627:therapeutic use*; D019172:Transplantation Conditioning / Q000379:methods; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents; D016572:Cyclosporine; D016559:Tacrolimus; D008727:Methotrexate
keywords: Aplastic anemia; Cyclosporine; Graft-versus-host disease; Hematopoietic cell transplantation; Immunosuppression; Tacrolimus