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Reduced dose of MTX for GVHD prophylaxis promotes engraftment and decreases non-relapse mortality in umbilical cord blood transplantation.
Annals of Hematology ( IF 3.0 ) Pub Date : 2020-02-01 , DOI: 10.1007/s00277-020-03937-3
Souichi Shiratori 1, 2 , Hiroyuki Ohigashi 1 , Shuichiro Takahashi 1 , Takahide Ara 1 , Hideki Goto 1 , Masao Nakagawa 1 , Junichi Sugita 1 , Masahiro Onozawa 1 , Kaoru Kahata 1 , Tomoyuki Endo 1 , Daigo Hashimoto 1 , Takanori Teshima 1 ,
Affiliation  

Although a combination of calcineurin inhibitor and methotrexate (MTX) is used for graft-versus-host disease (GVHD) prophylaxis in umbilical cord blood transplantation (CBT), optimal dose of MTX for CBT remains to be determined.We conducted a retrospective study to evaluate the safety and efficacy of standard-dose MTX (St-MTX, 15 mg/m2 on day 1 and 10 mg/m2 on days 3 and 6) and mini-dose MTX (Mini-MTX, 5 mg/m2 on days 1, 3 and 6) for GVHD prophylaxis in patients who underwent single unit CBT against hematological malignancies.Thirty-two and 26 patients received St-MTX and Mini-MTX, respectively. Cumulative incidence of neutrophil engraftment was significantly higher in the Mini-MTX group than in the St-MTX group (88.5% vs 65.6%, P = 0.00448). Cumulative incidences of grade II to IV and grade III to IV of acute graft-versus-host disease (GVHD) were 34.4% and 6.2% in the St-MTX group, and 34.6% and 7.7% in the Mini-MTX group with no statistical significance. One-year non-relapse mortality (NRM) was significantly lower in the Mini-MTX group compared to the St-MTX group (31.2% vs 3.8%, P = 0.00938), whereas relapse rate was not different between the groups. Multivariate analysis also indicated that Mini-MTX significantly improved engraftment (HR, 0.5359; 95% CI, 0.3082 to 0.9318; P = 0.0270) and reduced NRM (HR, 0.117; 95% CI, 0.0151 to 0.9067; P = 0.040).Our study suggests that GVHD prophylaxis using Mini-MTX in CBT is feasible and associated with improvement of engraftment and reduction in NRM.

中文翻译:

预防GVHD的MTX剂量的减少促进了脐带血移植的植入并降低了非复发死亡率。

尽管将钙调神经磷酸酶抑制剂和甲氨蝶呤(MTX)的组合用于预防脐带血移植(CBT)中的移植物抗宿主病(GVHD),但仍需要确定用于CBT的最佳MTX剂量。评估标准剂量MTX(St-MTX,第1天为15 mg / m2和第3和第6天为10 mg / m2)和小剂量MTX(Mini-MTX,第1天为5 mg / m2)的安全性和有效性(3和6)预防血液恶性肿瘤接受单单位CBT的患者的GVHD预防。分别有32例和26例患者接受了St-MTX和Mini-MTX。Mini-MTX组中性粒细胞植入的累积发生率显着高于St-MTX组(88.5%比65.6%,P = 0.00448)。急性移植物抗宿主病(GVHD)的II至IV级和III至IV级的累积发生率在St-MTX组中分别为34.4%和6.2%,在Mini-MTX组中为34.6%和7.7%,无统计学意义。与St-MTX组相比,Mini-MTX组的一年非复发死亡率(NRM)显着降低(31.2%vs 3.8%,P = 0.00938),而两组之间的复发率没有差异。多变量分析还表明,Mini-MTX显着改善了植入率(HR,0.5359; 95%CI,0.3082至0.9318; P = 0.0270)和NRM降低(HR,0.117; 95%CI,0.0151至0.9067; P = 0.040)。研究表明,在CBT中使用Mini-MTX预防GVHD是可行的,并且与移植的改善和NRM的减少有关。Mini-MTX组为7%,无统计学意义。与St-MTX组相比,Mini-MTX组的一年非复发死亡率(NRM)显着降低(31.2%vs 3.8%,P = 0.00938),而两组之间的复发率没有差异。多变量分析还表明,Mini-MTX显着改善了植入率(HR,0.5359; 95%CI,0.3082至0.9318; P = 0.0270)和NRM降低(HR,0.117; 95%CI,0.0151至0.9067; P = 0.040)。研究表明,在CBT中使用Mini-MTX预防GVHD是可行的,并且与移植的改善和NRM的减少有关。Mini-MTX组为7%,无统计学意义。与St-MTX组相比,Mini-MTX组的一年非复发死亡率(NRM)显着降低(31.2%vs 3.8%,P = 0.00938),而两组之间的复发率没有差异。多变量分析还表明,Mini-MTX显着改善了植入率(HR,0.5359; 95%CI,0.3082至0.9318; P = 0.0270)和NRM降低(HR,0.117; 95%CI,0.0151至0.9067; P = 0.040)。研究表明,在CBT中使用Mini-MTX预防GVHD是可行的,并且与移植的改善和NRM的减少有关。
更新日期:2020-02-01
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