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Monitoring mycophenolate mofetil is necessary for the effective prophylaxis of acute GVHD after cord blood transplantation

Bone Marrow Transplantation volume 50, pages 312–314 (2015)Cite this article

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Use of mycophenolate mofetil (MMF), a novel immunosuppressant that inhibits T- and B-cell proliferation, together with a calcineurin inhibitor (CNI) has recently increased in cord blood transplantation (CBT) to reduce severe GVHD and pre-engraftment syndrome (PES).1, 2 Wide interpatient variability has been reported in the plasma levels of mycophenolate (MPA), an active form of MMF, even after the same MMF exposure; however, few reports have performed therapeutic drug monitoring in CBT.3 Therefore, we performed a prospective cohort study to (1) determine the correlation between MPA concentration and incidence of severe PES or acute GVHD (aGVHD) after CBT and (2) compare the incidence of these complications with the historical cohort using CNI alone for GVHD prophylaxis after CBT.

We continuously enrolled 24 adult patients who underwent single-unit CBT with GVHD prophylaxis using CNI and MMF at our department between September 2011 and December 2013. The protocols were approved by the Ethics Committee of Kyoto University. The historical cohort consisted of 38 patients who received single-unit CBT with GVHD prophylaxis using CNI alone between June 2003 and August 2011. Patient characteristics and CBT procedures are summarized in Table 1, and definition of transplantation risk and myeloablative conditioning regimens were in accordance with previous studies.4, 5

Table 1 Patient characteristics
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Figure 1

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Acknowledgements

This study was supported by research funding from the Ministry of Education, Science, Sports and Culture in Japan.

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Authors and Affiliations

  1. Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan,

    Y Arai, T Kondo, T Kitano, M Hishizawa, K Yamashita, N Kadowaki & A Takaori-Kondo

  2. Department of Clinical Pharmacology and Therapeutics, Kyoto University Hospital, Kyoto, Japan,

    T Yamamoto, I Yano & K Matsubara

Authors
  1. Y Arai
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  2. T Kondo
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  3. T Kitano
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  4. M Hishizawa
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  5. K Yamashita
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  7. T Yamamoto
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  8. I Yano
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  9. K Matsubara
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  10. A Takaori-Kondo
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Corresponding author

Correspondence to T Kondo.

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The authors declare no conflict of interest.

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Arai, Y., Kondo, T., Kitano, T. et al. Monitoring mycophenolate mofetil is necessary for the effective prophylaxis of acute GVHD after cord blood transplantation. Bone Marrow Transplant 50, 312–314 (2015). https://doi.org/10.1038/bmt.2014.258

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