Prophylaxis with Sirolimus and Tacrolimus ± Antithymocyte Globulin Reduces the Risk of Acute Graft-versus-Host Disease without an Overall Survival Benefit Following Allogeneic Stem Cell Transplantation

• Published in: Biology of blood and marrow transplantation 2011-06, Vol.17 (6), p.916-922
• Main Authors: Rosenbeck, Lindsay L, Kiel, Patrick J, Kalsekar, Iftekhar, Vargo, Craig, Baute, John, Sullivan, Cheryl K, Wood, Lisa, Abdelqader, Sahar, Schwartz, Jennifer, Srivastava, Shivani, Abonour, Rafat, Robertson, Michael J, Nelson, Robert P, Cornetta, Kenneth, Fausel, Christopher A, Farag, Sherif S
• Format: Article
• Language: English
• Subjects: Adult; Antilymphocyte Serum - therapeutic use; Calcineurin Inhibitors; Cyclosporine - therapeutic use; Female; Graft vs Host Disease - complications; Graft vs Host Disease - drug therapy; Graft vs Host Disease - immunology; Graft vs Host Disease - mortality; Graft vs Host Disease - pathology; Graft vs Host Disease - prevention & control; Graft-versus-host disease; Hematologic Neoplasms - pathology; Hematologic Neoplasms - therapy; Hematology, Oncology and Palliative Medicine; Hematopoietic Stem Cell Transplantation; Humans; Immunosuppressive Agents - therapeutic use; Lung Diseases, Interstitial - etiology; Lung Diseases, Interstitial - pathology; Male; Methotrexate - therapeutic use; Middle Aged; Retrospective Studies; Risk Factors; Sinusoidal obstructive syndrome; Sirolimus; Sirolimus - therapeutic use; Stem cell transplant; Survival Analysis; Tacrolimus; Tacrolimus - therapeutic use; Thrombotic Microangiopathies - etiology; Thrombotic Microangiopathies - pathology; Transplantation Conditioning - methods; Transplantation, Homologous; Young Adult
• ISSN: 1083-8791; 1523-6536
• DOI: 10.1016/j.bbmt.2010.09.017

Methotrexate (MTX) is a standard agent used in combination with calcineurin inhibitors for graft-versus-host disease (GVHD) prophylaxis in patients undergoing allogeneic hematopoietic cell (HCT) transplantation. We retrospectively compared the incidence of acute GVHD (aGVHD), transplant-related morbidity, and mortality in patients given sirolimus/tacrolimus ± antithymocyte globulin (ATG) versus MTX/tacrolimus or cyclosporine and allogeneic transplantation for hematologic malignancies. Between January 1, 2005, and April 30, 2009, 106 consecutive patients received peripheral blood HCT or bone marrow grafts after 1 of 6 myeloablative conditioning regimens. The incidence of grade II-IV aGVHD was 18.6% in patients who received sirolimus/tacrolimus compared to 48.9% who received MTX ( P = .001). The incidence of grade III-IV aGVHD was 5% and 17% ( P = .045), respectively. There was no difference in overall survival (OS) between the groups ( P  = .160). Chronic GVHD (cGVHD) occurred in 40.4% who received sirolimus and 41.9% receiving MTX ( P = .89). The incidence of thrombotic microangiopathy or interstitial pneumonitis was not significantly different between groups. The reduction in the risk of severe aGVHD was offset by an increased (20% versus 4%, P  = .015) incidence of and mortality from sinusoidal obstructive syndrome (SOS). Sirolimus/tacrolimus appears to reduce the incidence of aGVHD after conventional allotransplantion compared to MTX-calcineurin inhibitor prophylaxis; however, this did not improve survival.