A comparison of tacrolimus and cyclosporine combined with methotrexate for graft-versus-host disease prophylaxis, stratified by stem cell source: a retrospective nationwide survey

Rika Sakai, Masataka Taguri, Kumi Oshima, Takehiko Mori, Hiroatsu Ago, Souichi Adachi, Satoshi Morita, Shuichi Taniguchi, Takahiro Fukuda, Kazuteru Ohashi, Tetsuya Eto, Koichi Miyamura, Koji Iwato, Naoki Kobayashi, Heiwa Kanamori, Yasuo Morishima, Tokiko Nagamura-Inoue, Hisashi Sakamaki, Yoshiko Atsuta, Makoto Murata

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Abstract

This nationwide, retrospective study compared the efficacy of cyclosporine and tacrolimus with methotrexate (CsA/MTX and TAC/MTX) for acute graft-versus-host disease (aGVHD) prevention and transplant-related outcomes. Data were obtained from the Transplant Registry Unified Management Program of the Japan Society for Hematopoietic Cell Transplantation for ≥16-year-old leukemia patients who received CsA/MTX or TAC/MTX after bone marrow transplantation and peripheral blood stem cell transplantation from serological HLA-matched related donors (MRD), HLA 8/8 allele-matched, or one allele-mismatched unrelated bone marrow (UBM), or 0–2 antigen-mismatched unrelated cord blood (UCB) transplantation between January 2005 and December 2009. Separate analyses were performed for each cohort. Adjusted multivariate analyses indicated that in the MRD (n = 1524) and the UBM (n = 1466) cohorts, TAC/MTX significantly reduced grade II–IV aGVHD risk (HR 0.58, P = 0.006 and HR 0.77, P = 0.015, respectively) without affecting the other transplant-related outcomes. In the UCB cohort (n = 925), TAC/MTX significantly reduced the risk of non-relapse mortality (HR 0.63, P = 0.027) and chronic GVHD (HR 0.60, P = 0.02) without significant effects on grade II–IV aGVHD (HR 0.83, P = 0.21). Our results may provide the most up-to-date data regarding GVHD prevention in Japan.

Original languageEnglish
Pages (from-to)322-333
Number of pages12
JournalInternational Journal of Hematology
Volume103
Issue number3
DOIs
Publication statusPublished - 2016 Mar 1

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Keywords

  • Cyclosporine
  • Graft-versus-host disease
  • Methotrexate
  • Tacrolimus

ASJC Scopus subject areas

  • Hematology

Cite this

Sakai, R., Taguri, M., Oshima, K., Mori, T., Ago, H., Adachi, S., Morita, S., Taniguchi, S., Fukuda, T., Ohashi, K., Eto, T., Miyamura, K., Iwato, K., Kobayashi, N., Kanamori, H., Morishima, Y., Nagamura-Inoue, T., Sakamaki, H., Atsuta, Y., & Murata, M. (2016). A comparison of tacrolimus and cyclosporine combined with methotrexate for graft-versus-host disease prophylaxis, stratified by stem cell source: a retrospective nationwide survey. International Journal of Hematology, 103(3), 322-333. https://doi.org/10.1007/s12185-016-1939-9