title: Umbilical cord blood transplantation for adults using tacrolimus with two-day very-short-term methotrexate for graft-versus-host disease prophylaxis.
abstract: Cord blood transplantation (CBT) is an alternative approach to allogeneic stem cell transplantation. However, CBT is associated with issues including pre-engraftment immune reaction (PIR), engraftment syndrome (ES), and graft failure (GF). Tacrolimus (TAC) and short-term methotrexate (sMTX: days 1, 3, 6, and/or 11) are used for graft-versus-host disease (GVHD) prophylaxis during CBT; however, sMTX does not accelerate neutrophil engraftment. Therefore, we hypothesized that lower doses of sMTX [very-short-term MTX (vsMTX): 10 and 7mg/m(2) on days 1 and 3, respectively] with TAC reduce the risk of GF without increasing post-transplantation immune reactions during CBT. We retrospectively analyzed 40 patients who received TAC with vsMTX for GVHD prophylaxis. PIR and ES developed in 4 patients. The cumulative incidence of neutrophil engraft at day 60 was 92.5%. No cases of primary graft failure were noted. The cumulative incidence of grades II-III GVHD was 48.1% at day 100, and the cumulative 100-day incidence of nonrelapse mortality was 12.5%. This study suggests that TAC with vsMTX reduces the risk of PIR and ES during CBT and stimulates neutrophil engraftment, but may be associated with slightly higher aGVHD compared with calcineurin inhibitor and sMTX. Therefore, we recommend vsMTX plus TAC as an option for GVHD prophylaxis during CBT.
authors.affiliation: Division of Hematology, Department of Medicine, Showa University School of Medicine 142-8666 1-5-8 Hatanodai, Shinagawa-Ku, Tokyo, Japan. Electronic address: b-saito@med.showa-u.ac.jp.
authors.forename: Bungo
authors.initials: B
authors.lastname: Saito
authors.affiliation: Division of Hematology, Department of Medicine, Showa University School of Medicine 142-8666 1-5-8 Hatanodai, Shinagawa-Ku, Tokyo, Japan.
authors.forename: Norimichi
authors.initials: N
authors.lastname: Hattori
authors.affiliation: Division of Hematology, Department of Medicine, Showa University School of Medicine 142-8666 1-5-8 Hatanodai, Shinagawa-Ku, Tokyo, Japan.
authors.forename: Kohei
authors.initials: K
authors.lastname: Yamamoto
authors.affiliation: Division of Hematology, Department of Medicine, Showa University School of Medicine 142-8666 1-5-8 Hatanodai, Shinagawa-Ku, Tokyo, Japan.
authors.forename: Nana
authors.initials: N
authors.lastname: Arai
authors.affiliation: Division of Hematology, Department of Medicine, Showa University School of Medicine 142-8666 1-5-8 Hatanodai, Shinagawa-Ku, Tokyo, Japan.
authors.forename: Yukiko
authors.initials: Y
authors.lastname: Kawaguchi
authors.affiliation: Division of Hematology, Department of Medicine, Showa University School of Medicine 142-8666 1-5-8 Hatanodai, Shinagawa-Ku, Tokyo, Japan.
authors.forename: Shun
authors.initials: S
authors.lastname: Fujiwara
authors.affiliation: Division of Hematology, Department of Medicine, Showa University School of Medicine 142-8666 1-5-8 Hatanodai, Shinagawa-Ku, Tokyo, Japan.
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Kabasawa
authors.affiliation: Division of Hematology, Department of Medicine, Showa University School of Medicine 142-8666 1-5-8 Hatanodai, Shinagawa-Ku, Tokyo, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Tsukamoto
authors.affiliation: Division of Hematology, Department of Medicine, Showa University School of Medicine 142-8666 1-5-8 Hatanodai, Shinagawa-Ku, Tokyo, Japan.
authors.forename: Yui
authors.initials: Y
authors.lastname: Uto
authors.affiliation: Division of Hematology, Department of Medicine, Showa University School of Medicine 142-8666 1-5-8 Hatanodai, Shinagawa-Ku, Tokyo, Japan.
authors.forename: Hirotsugu
authors.initials: H
authors.lastname: Ariizumi
authors.affiliation: Division of Hematology, Department of Medicine, Showa University School of Medicine 142-8666 1-5-8 Hatanodai, Shinagawa-Ku, Tokyo, Japan.
authors.forename: Kouji
authors.initials: K
authors.lastname: Yanagisawa
authors.affiliation: Division of Hematology, Department of Medicine, Showa University School of Medicine 142-8666 1-5-8 Hatanodai, Shinagawa-Ku, Tokyo, Japan.
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Nakamaki
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D036101:Cord Blood Stem Cell Transplantation / Q000379:methods*; D005260:Female; D006085:Graft Survival; D006086:Graft vs Host Disease / Q000517:prevention & control*; D006801:Humans; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage*; D008875:Middle Aged; D009504:Neutrophils / Q000166:cytology; D011292:Premedication / Q000379:methods; D012189:Retrospective Studies; D016559:Tacrolimus / Q000008:administration & dosage*; D055815:Young Adult
chemical_list: D016559:Tacrolimus; D008727:Methotrexate
keywords: Cord blood transplantation; Graft-versus-host disease prophylaxis; Methotrexate