title: Cyclosporine Plus Methotrexate or Cyclosporine Plus Mycophenolate Mofetil as Graft Versus Host Disease Prophylaxis in Acute Leukemia Transplant: Comparison of Toxicity, Engraftment Kinetics and Transplant Outcome.
abstract: We sought to compare two graft-versus-host disease (GVHD) prophylaxis regimen, cyclosporine and methotrexate (CsA+MTX) with CsA+mycophenolate mofetil (MMF) in 77 acute leukemia patients who underwent hematopoietic stem cell transplant (HSCT) between January 2008 and March 2013. Fifty-three patients received CsA+MTX while 24 received CsA+MMF. The incidence of grade 3-4 mucositis and grade 3-4 diarrhea was 74 and 6 % with CsA+MTX compared to 33 % and 21 % with CsA+MMF (P = 0.001 and 0.09 respectively). Forty-two (79 %) patients in CsA+MTX group required total parenteral nutrition compared to 14 (58 %) in CsA+MMF group (P = 0.09). The incidence of engraftment fever was 17 % with CsA+MTX and 41 % with CsA+MMF (P = 0.02). The median time to neutrophil and platelet engraftment was 14 days and 13 days with CsA+MTX compared to 12 days and 10 days with CsA+MMF (P = 0.003 and 0.08 respectively). The incidence of any grade and grade II-IV acute GVHD was 45 and 13 % with CsA+MTX compared to 42 and 29 % with CsA+MMF (P = NS). Incidence of overall and extensive chronic GVHD was 57 and 38 % with CsA+MTX compared to 42 and 17 % with CsA+MMF (P = NS). Incidence of relapse was 38 % with CsA+MTX compared to 33 % with CsA+MMF (P = NS). TRM was 6 % with CsA+MTX and 21 % with CsA+MMF (P = NS). At 2 years, overall survival (OS) was 64 % in CsA+MTX group compared to 46 % in CsA+MMF group (P = NS). We conclude that CsA+MMF is associated with lesser toxicity, faster myeloid engraftment and similar rates of acute and chronic GVHD, TRM, relapse and OS compared to CsA+MTX in acute leukemia transplant.
authors.affiliation: Bone Marrow Transplant Unit, Department of Medical Oncology, ACTREC, Tata Memorial Centre, Sector 22, Room No. 247, Paymaster Shodhika, Kharghar, Navi-Mumbai, 410210 India.
authors.forename: Alok
authors.initials: A
authors.lastname: Gupta
authors.affiliation: Bone Marrow Transplant Unit, Department of Medical Oncology, ACTREC, Tata Memorial Centre, Sector 22, Room No. 247, Paymaster Shodhika, Kharghar, Navi-Mumbai, 410210 India.
authors.forename: Sachin
authors.initials: S
authors.lastname: Punatar
authors.affiliation: Bone Marrow Transplant Unit, Department of Medical Oncology, ACTREC, Tata Memorial Centre, Sector 22, Room No. 247, Paymaster Shodhika, Kharghar, Navi-Mumbai, 410210 India.
authors.forename: Libin
authors.initials: L
authors.lastname: Mathew
authors.affiliation: Department of Biostatistics, ACTREC, Tata Memorial Centre, Sector 22, Kharghar, Navi-Mumbai, India.
authors.forename: Sadhana
authors.initials: S
authors.lastname: Kannan
authors.affiliation: Bone Marrow Transplant Unit, Department of Medical Oncology, ACTREC, Tata Memorial Centre, Sector 22, Room No. 247, Paymaster Shodhika, Kharghar, Navi-Mumbai, 410210 India.
authors.forename: Navin
authors.initials: N
authors.lastname: Khattry
keywords: Cyclosporine; Graft-versus-host disease; Hematopoietic stem cell transplantation; Methotrexate; Mycophenolate mofetil