title: Exploratory research for optimal GvHD prophylaxis after single unit CBT in adults: short-term methotrexate reduced the incidence of severe GvHD more than mycophenolate mofetil.
abstract: In order to examine GvHD prophylaxis in umbilical cord blood transplantation (UCBT) in more detail, we compared transplant outcomes after UCBT for acute leukemia among GvHD prophylaxes using registry data. We selected patients transplanted with a calcineurin inhibitor and methotrexate (MTX)/mycophenolate mofetil (MMF) combination. A total of 1516 first myeloablative UCBT between 2000 and 2012 (Cyclosporine A (CyA) plus MTX, 824, Tacrolimus (Tac) plus MTX, 554, Tac plus MMF, 138) were included. With adjusted analyses, Tac plus MMF showed a significantly higher risk for grade II-IV and III-IV acute GvHD than CyA or Tac plus MTX. Although NRM was similar, Tac plus MMF showed a significantly lower risk of relapse than CyA or Tac plus MTX. A significant difference was observed in the risk of overall mortality (OM) between the MTX-containing group and MMF-containing group. In patients with standard-risk disease, there was no significant difference in the risk of OM in any GvHD prophylaxis. However, in patients with advanced-risk disease, Tac plus MMF showed a significantly lower risk of OM. Therefore, MTX-containing prophylaxis is preferred in UCBT for standard-risk disease, whereas MMF-containing prophylaxis is preferred for advanced-risk disease. A prospective study to identify optimal GvHD prophylaxis for UCBT is warranted.
authors.affiliation: Department of Hematology and Oncology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
authors.forename: S
authors.identifier: http://orcid.org/0000-0002-1194-8046
authors.initials: S
authors.lastname: Terakura
authors.affiliation: Department of Hematology, Toranomon Hospital Kajigaya, Kawasaki, Japan.|Okinaka Memorial Institute of Medical Research, Tokyo, Japan.
authors.forename: A
authors.identifier: http://orcid.org/0000-0002-9653-6170
authors.initials: A
authors.lastname: Wake
authors.affiliation: Division of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Inamoto
authors.affiliation: Department of Hematology and Oncology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
authors.forename: M
authors.initials: M
authors.lastname: Murata
authors.affiliation: Department of Medical Oncology, Kanagawa Cancer Center, Yokohama, Japan.
authors.forename: R
authors.initials: R
authors.lastname: Sakai
authors.affiliation: Division of Biostatistics, Tohoku University Graduate School of Medicine, Sendai, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Yamaguchi
authors.affiliation: Department of Cell Processing and Transfusion, Research Hospital, Institute of Medical Science, University of Tokyo, Tokyo, Japan.
authors.forename: S
authors.initials: S
authors.lastname: Takahashi
authors.affiliation: Okinaka Memorial Institute of Medical Research, Tokyo, Japan.|Department of Hematology, Toranomon Hospital, Tokyo, Japan.
authors.forename: N
authors.initials: N
authors.lastname: Uchida
authors.affiliation: Department of Hematology and Rheumatology, Tohoku University Hospital, Sendai, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Onishi
authors.affiliation: Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Ohashi
authors.affiliation: Department of Hematology, Japanese Red Cross Nagoya First Hospital, Nagoya, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Ozawa
authors.affiliation: Department of Hematology, Kanagawa Cancer Center, Yokohama, Japan.
authors.forename: H
authors.initials: H
authors.lastname: Kanamori
authors.affiliation: Department of Hematology, Nippon Medical School, Tokyo, Japan.
authors.forename: H
authors.initials: H
authors.lastname: Yamaguchi
authors.affiliation: Division of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Fukuda
authors.affiliation: Department of Hematology and Oncology, Hiroshima University Hospital, Hiroshima, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Ichinohe
authors.affiliation: Blood Service Headquarters, Japanese Red Cross Society, Tokyo, Japan.
authors.forename: M
authors.initials: M
authors.lastname: Takanashi
authors.affiliation: Japanese Data Center for Hematopoietic Cell Transplantation, Nagoya, Japan.|Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Atsuta
authors.affiliation: Department of Hematology, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Teshima
mesh_terms: D000293:Adolescent; D000328:Adult; D036101:Cord Blood Stem Cell Transplantation; D016572:Cyclosporine / Q000008:administration & dosage; D018572:Disease-Free Survival; D005260:Female; D006086:Graft vs Host Disease / Q000401:mortality* / Q000517:prevention & control*; D006801:Humans; D015994:Incidence; D007564:Japan; D015470:Leukemia, Myeloid, Acute / Q000401:mortality / Q000628:therapy; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage*; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000008:administration & dosage*; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000401:mortality / Q000628:therapy; D012042:Registries; D015996:Survival Rate; D016559:Tacrolimus / Q000008:administration & dosage
chemical_list: D016572:Cyclosporine; D009173:Mycophenolic Acid; D016559:Tacrolimus; D008727:Methotrexate