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Cord Blood Stem Cells

Short-term methotrexate could reduce early immune reactions and improve outcomes in umbilical cord blood transplantation for adults

Bone Marrow Transplantation volume 39, pages 31–39 (2007)Cite this article

Abstract

Post transplant immune disorders are problematic in cord blood transplantation (CBT) for adult patients, and optimal prophylaxis has not been established. We investigated whether intensive graft-versus-host disease (GVHD) prophylaxis using short-term methotrexate (MTX) has a prognostic impact on CBT. Post-CBT immune reactions were classified according to time course as pre-engraftment immune reaction (PIR), engraftment syndrome (ES) or acute GVHD. Between March 2001 and November 2005, a total of 77 patients underwent CBT at eight transplantation centers. Median age was 48 years (range, 18–69 years). Preparative regimens comprised myeloablative (n=31) or reduced-intensity (n=46). Acute GVHD prophylaxis included cyclosporine alone (n=23), tacrolimus alone (n=12), cyclosporine plus MTX (n=17), tacrolimus plus short-term MTX (n=23) or cyclosporine plus methylprednisolone (n=2). Cumulative incidences of PIR, ES and grade II–IV GVHD were 36, 12 and 23%, respectively. Short-term MTX exerted significant favorable effects on post-CBT immune reactions (hazard ratio, 0.55; 95% confidence interval (95% CI), 0.31–0.98; P=0.04) in multivariate analysis. Overall survival rates for patients with and without short-term MTX at day 180 were 59% (95% CI, 42–73%) and 16% (95% CI, 6.6–30%) (P=0.0001), respectively. Short-term MTX could offer one optimal regimen to reduce immune reactions and improve outcomes in CBT.

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Acknowledgements

We thank Professor Tomoki Naoe (Nagoya University Graduate School of Medicine) for his critical reading of the paper. We wish to thank all the staff and resident members of the participating institutions. A complete list of participating institutions appears in the Appendix.

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Authors and Affiliations

  1. Department of Hematology, Toyohashi Municipal Hospital, Toyohashi, Japan

    H Narimatsu

  2. Department of Hematology and Oncology, Nagoya University Graduate School of Medicine, Nagoya, Japan

    H Narimatsu, S Terakura & M Murata

  3. Division of Epidemiology and Prevention, Aichi Cancer Center Research Institute, Nagoya, Japan

    K Matsuo

  4. Department of Hematology, Japanese Red Cross Nagoya First Hospital, Nagoya, Japan

    T Oba & K Miyamura

  5. Department of Hematology, Nagoya Daini Red Cross Hospital, Nagoya, Japan

    T Uchida

  6. Department of Hematology, Meitetsu Hospital, Nagoya, Japan

    H Iida

  7. Department of Hematology, Clinical and Research Center, National Hospital Organization Nagoya Medical Center, Nagoya, Japan

    M Hamaguchi

  8. Department of Hematology, Fujita Health University Hospital, Toyoake, Japan

    M Watanabe

  9. Division of Hematology and Oncology, JA Aichi Showa Hospital, Konan, Japan

    A Kohno & Y Morishita

  10. Department of Hematology, Anjo Kosei Hospital, Anjo, Japan

    M Sawa

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for the Nagoya Blood and Marrow Transplantation Group (NBMTG)

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Correspondence to H Narimatsu.

Appendix

Appendix

This study was conducted at the following institutions in NBMTG: Japanese Red Cross Nagoya First Hospital, Nagoya; Nagoya Daini Red Cross Hospital, Nagoya; Meitetsu Hospital, Nagoya; National Hospital Organization Nagoya Medical Center, Clinical and Research Center, Nagoya; Fujita Health University Hospital, Toyoake; JA Aichi Showa Hospital, Konan; Nagoya University Hospital, Nagoya; and Anjo Kosei Hospital, Anjo, Japan.

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Narimatsu, H., Terakura, S., Matsuo, K. et al. Short-term methotrexate could reduce early immune reactions and improve outcomes in umbilical cord blood transplantation for adults. Bone Marrow Transplant 39, 31–39 (2007). https://doi.org/10.1038/sj.bmt.1705539

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