Tacrolimus instead of cyclosporine used for prophylaxis against graft-versus-host disease improves outcome after hematopoietic stem cell transplantation from unrelated donors, but not from HLA-identical sibling donors: A nationwide survery conducted in Japan

M. Yanada, N. Emi, T. Naoe, H. Sakamaki, S. Takahashi, N. Hirabayashi, A. Hiraoka, Y. Kanda, Ryuji Tanosaki, Shinichiro Okamoto, K. Iwato, Y. Atsuta, N. Hamajima, M. Tanimoto, S. Kato

Research output: Contribution to journalArticle

44 Citations (Scopus)

Abstract

Despite recent advances, graft-versus-host disease (GVHD) remains the main cause of treatment failure for patients undergoing allogeneic hematopoietic stem cell transplantation (HSCT). Tacrolimus (FK506) has been increasingly used in place of cyclosporine (CSP), and several studies have shown that FK506 reduces the incidence of acute GVHD more effectively than does CSP. However, no survival benefits have been demonstrated, and no established consensus exists on the choice of these immunosuppressive agents. To compare a CSP-based and an FK506-based regimen, we performed a large-scale retrospective study by using the data of 1935 patients who underwent HSCT from HLA-identical sibling donors (SIB-HSCT) and 777 patients who underwent HSCT from unrelated donors (UD-HSCT). For patients undergoing UD-HSCT, FK506 significantly reduced the risk of acute GVHD and treatment-related mortality (TRM) without an increase in relapse, thus improving overall survival (OS) (hazard ratio (HR): 2.20, 95% confidence interval (CI): 1.60-3.04, P < 0.0001 for grade II-IV acute GVHD; HR: 1.81, 95% CI: 1.32-2.48, P = 0.0003 for TRM; HR: 1.62, 95% CI: 1.23-2.14, P = 0.0007 for OS). This superiority of FK506 was not observed in SIB-HSCT cases. These findings indicate that the use of FK506 instead of CSP for GVHD prophylaxis is beneficial for patients undergoing UD-HSCT.

Original languageEnglish
Pages (from-to)331-337
Number of pages7
JournalBone Marrow Transplantation
Volume34
Issue number4
DOIs
Publication statusPublished - 2004 Aug

Fingerprint

Unrelated Donors
Hematopoietic Stem Cell Transplantation
Tacrolimus
Graft vs Host Disease
Cyclosporine
Siblings
Japan
Tissue Donors
Confidence Intervals
Survival
Mortality
Immunosuppressive Agents
Treatment Failure
Consensus
Retrospective Studies
Recurrence
Incidence
Therapeutics

Keywords

  • Cyclosporine
  • Graft-verus-host disease
  • Hematopoietic stem cell transplantation
  • Tacrolimus

ASJC Scopus subject areas

  • Hematology
  • Transplantation

Cite this

Tacrolimus instead of cyclosporine used for prophylaxis against graft-versus-host disease improves outcome after hematopoietic stem cell transplantation from unrelated donors, but not from HLA-identical sibling donors : A nationwide survery conducted in Japan. / Yanada, M.; Emi, N.; Naoe, T.; Sakamaki, H.; Takahashi, S.; Hirabayashi, N.; Hiraoka, A.; Kanda, Y.; Tanosaki, Ryuji; Okamoto, Shinichiro; Iwato, K.; Atsuta, Y.; Hamajima, N.; Tanimoto, M.; Kato, S.

In: Bone Marrow Transplantation, Vol. 34, No. 4, 08.2004, p. 331-337.

Research output: Contribution to journalArticle

Yanada, M. ; Emi, N. ; Naoe, T. ; Sakamaki, H. ; Takahashi, S. ; Hirabayashi, N. ; Hiraoka, A. ; Kanda, Y. ; Tanosaki, Ryuji ; Okamoto, Shinichiro ; Iwato, K. ; Atsuta, Y. ; Hamajima, N. ; Tanimoto, M. ; Kato, S. / Tacrolimus instead of cyclosporine used for prophylaxis against graft-versus-host disease improves outcome after hematopoietic stem cell transplantation from unrelated donors, but not from HLA-identical sibling donors : A nationwide survery conducted in Japan. In: Bone Marrow Transplantation. 2004 ; Vol. 34, No. 4. pp. 331-337.
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abstract = "Despite recent advances, graft-versus-host disease (GVHD) remains the main cause of treatment failure for patients undergoing allogeneic hematopoietic stem cell transplantation (HSCT). Tacrolimus (FK506) has been increasingly used in place of cyclosporine (CSP), and several studies have shown that FK506 reduces the incidence of acute GVHD more effectively than does CSP. However, no survival benefits have been demonstrated, and no established consensus exists on the choice of these immunosuppressive agents. To compare a CSP-based and an FK506-based regimen, we performed a large-scale retrospective study by using the data of 1935 patients who underwent HSCT from HLA-identical sibling donors (SIB-HSCT) and 777 patients who underwent HSCT from unrelated donors (UD-HSCT). For patients undergoing UD-HSCT, FK506 significantly reduced the risk of acute GVHD and treatment-related mortality (TRM) without an increase in relapse, thus improving overall survival (OS) (hazard ratio (HR): 2.20, 95{\%} confidence interval (CI): 1.60-3.04, P < 0.0001 for grade II-IV acute GVHD; HR: 1.81, 95{\%} CI: 1.32-2.48, P = 0.0003 for TRM; HR: 1.62, 95{\%} CI: 1.23-2.14, P = 0.0007 for OS). This superiority of FK506 was not observed in SIB-HSCT cases. These findings indicate that the use of FK506 instead of CSP for GVHD prophylaxis is beneficial for patients undergoing UD-HSCT.",
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AU - Emi, N.

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AU - Sakamaki, H.

AU - Takahashi, S.

AU - Hirabayashi, N.

AU - Hiraoka, A.

AU - Kanda, Y.

AU - Tanosaki, Ryuji

AU - Okamoto, Shinichiro

AU - Iwato, K.

AU - Atsuta, Y.

AU - Hamajima, N.

AU - Tanimoto, M.

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