Short-term methotrexate plus cyclosporine for graft-versus-host disease prophylaxis after single-unit cord blood transplantation following reduced-intensity conditioning

• Sugio Takeshi

  Department of Medicine and Biosystemic Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan Department of Hematology, Hamanomachi Hospital, Fukuoka, Japan

• Kato Koji

  Department of Medicine and Biosystemic Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan

• Yoshida Shuro

  Department of Hematology, Hamanomachi Hospital, Fukuoka, Japan

• Saito Noriyuki

  Department of Hematology, Hamanomachi Hospital, Fukuoka, Japan

• Kawano Ichiro

  Department of Hematology, Hamanomachi Hospital, Fukuoka, Japan

• Henzan Hideho

  Department of Hematology, Hamanomachi Hospital, Fukuoka, Japan

• Miyamoto Toshihiro

  Department of Medicine and Biosystemic Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan

• Akashi Koichi

  Department of Medicine and Biosystemic Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan

• Eto Tetsuya

  Department of Hematology, Hamanomachi Hospital, Fukuoka, Japan

抄録

 Background: Cord blood is an alternative donor source for patients without HLA-matched donors. Calcineurin inhibitors (CNIs) alone, as prophylaxis for graft-versus-host disease (GVHD) in cord blood transplantation (CBT) patients, reportedly increase the incidence of severe pre-engraftment immune reaction (PIR), leading to transplant-related mortality (TRM) with primary engraft failure and multiple organ dysfunctions. Therefore, additional immunosuppressive agents are needed. Reportedly, short-term methotrexate (sMTX) plus CNIs improved outcomes in patients receiving CBT with full-intensity conditioning (FIC) regimens; however, safety and efficacy of sMTX plus cyclosporine have not been assessed in patients receiving CBT with reduced-intensity conditioning (RIC) regimens. Methods: We retrospectively analyzed 43 patients who received single-unit CBT and were treated with sMTX plus cyclosporine (RIC group, 15; FIC group, 28). Results: Neutrophil engraftment rate was significantly lower in RIC group (53.3%) than in FIC group (78.6%, P=0.04). Cumulative incidence of TRM tended to be higher in the RIC group than in the FIC group (P=0.12); the leading cause of death in the RIC group was bacterial infections. Conclusions: sMTX plus cyclosporine does not seem feasible for treating patients receiving single-unit CBT following RIC. MTX dose optimization or alternative immunosuppressive agent application should be considered in such patients.

収録刊行物

• 日本造血・免疫細胞療法学会雑誌

  日本造血・免疫細胞療法学会雑誌 11 (1), 64-71, 2022

  一般社団法人 日本造血・免疫細胞療法学会

キーワード

• Cord blood transplantation
• Methotrexate
• Cyclosporine
• Graft-versus-host disease
• Reduced-intensity conditioning

詳細情報

• CRID: 1390572244905221248
• NII論文ID: 130008142095
• DOI: 10.7889/tct-21-001
• ISSN: 2436455X
• Web Site: https://www.jstage.jst.go.jp/article/tct/11/1/11_21-001/_pdf
• Web Site: https://search.jamas.or.jp/link/ui/2022320136
• 本文言語コード: ja
• データソース種別:
  • JaLC
  • Crossref
  • CiNii Articles
  • KAKEN
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