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GVHD prophylaxis by tacrolimus and mini-MTX in single-unit CBT: a single institute experience.
International Journal of Hematology ( IF 2.1 ) Pub Date : 2019-10-28 , DOI: 10.1007/s12185-019-02762-3
Shigeo Fuji 1 , Yuma Tada 1 , Ryo Nakata 1 , Keiichi Nakata 1 , Midori Koike 1 , Shuhei Kida 1 , Kazuhito Tsutsumi 1 , Hiroaki Masaie 1 , Hitoshi Yoshida 1 , Jun Ishikawa 1
Affiliation  

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/m2 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.

中文翻译:

他克莫司和mini-MTX在单单位CBT中预防GVHD:单一机构的经验。

他克莫司(TAC)与短期甲氨蝶呤(MTX)的结合被广泛用于预防脐血移植(CBT)中的移植物抗宿主病(GVHD)。由于短期MTX加重了粘膜炎并延迟了植入,我们减少了MTX的剂量,如先前在非CBT设置中报道的那样。在这里,我们回顾性分析了2017年4月至2018年12月期间接受CBT的20例患者的预后。所有患者均接受了TAC和mini-MTX预防GVHD。在CBT后第1、3和6天以5 mg / m2的MTX剂量给予Mini-MTX。中位年龄是54.5岁。存活患者的中位随访时间为396天。原发疾病为急性白血病(n = 12)或恶性淋巴瘤(n = 8)。3例患者和17例患者分别接受了清髓和降低强度的调节。中性粒细胞的植入率和中位时间分别为90.0%和20.5天。II-IV级和III-IV级急性GVHD的累积发生率分别为35.0%和5.0%。CBT后一年,总生存率为80.5%,复发/进展的累积发生率为15.0%,非复发死亡率为5.0%。总之,TAC与mini-MTX在单单位CBT中可能是有希望的GVHD预防方案。
更新日期:2020-01-26
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