GVHD prophylaxis by tacrolimus and mini-MTX in single-unit CBT: a single institute experience

Tacrolimus (TAC) combined with short-term methotrexate (MTX) is widely used to prevent graft-versus-host disease (GVHD) in cord blood transplantation (CBT). As short-term MTX aggravates mucositis and delays engraftment, we reduced the dose of MTX, as previously reported in the non-CBT setting. Here,...

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Bibliographic Details
Published in:International journal of hematology 2020-02, Vol.111 (2), p.278-283
Main Authors: Fuji, Shigeo, Tada, Yuma, Nakata, Ryo, Nakata, Keiichi, Koike, Midori, Kida, Shuhei, Tsutsumi, Kazuhito, Masaie, Hiroaki, Yoshida, Hitoshi, Ishikawa, Jun
Format: Article
Language:English
Subjects:
Cord blood
Drug Therapy, Combination
Graft vs Host Disease - mortality
Graft vs Host Disease - prevention & control
Graft-versus-host reaction
Hematology
Humans
Leukemia
Leukocytes (neutrophilic)
Lymphoma
Medicine
Medicine & Public Health
Methotrexate
Methotrexate - administration & dosage
Mucositis
Oncology
Original Article
Prophylaxis
Recurrence
Retrospective Studies
Survival Rate
Tacrolimus
Tacrolimus - administration & dosage
Transplantation
Treatment Outcome
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Summary:Tacrolimus (TAC) combined with short-term methotrexate (MTX) is widely used to prevent graft-versus-host disease (GVHD) in cord blood transplantation (CBT). As short-term MTX aggravates mucositis and delays engraftment, we reduced the dose of MTX, as previously reported in the non-CBT setting. Here, we retrospectively analyze outcomes of 20 patients who received CBT from April 2017 to December 2018. All patients received TAC with mini-MTX as GVHD prophylaxis. Mini-MTX was administered at a dose of 5 mg/m 2 of MTX on days 1, 3 and 6 after CBT. Median age was 54.5 years. Median follow-up time in surviving patients was 396 days. The primary disease was acute leukemia ( n  = 12) or malignant lymphoma ( n  = 8). Three patients and 17 patients received myeloablative and reduced-intensity conditioning, respectively. Rate and median time to engraftment of neutrophils were 90.0% and 20.5 days, respectively. Cumulative incidences of grade II–IV and grade III–IV acute GVHD were 35.0% and 5.0%, respectively. At one year after CBT, the overall survival rate was 80.5%, cumulative incidence of relapse/progression was 15.0%, and non-relapse mortality rate was 5.0%. In conclusion, TAC with mini-MTX may be a promising GVHD prophylaxis regimen in single-unit CBT.
ISSN:0925-5710
1865-3774
DOI:10.1007/s12185-019-02762-3