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：

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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。