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Graft Versus Host Disease

Tacrolimus (FK506) and methotrexate as prophylaxis for acute graft-versus-host disease in pediatric allogeneic stem cell transplantation

Bone Marrow Transplantation volume 26, pages 161–167 (2000)Cite this article

Abstract

Currently, limited data exist on the role of tacrolimus (FK506) in pediatric allogeneic marrow transplantation. Forty-one patients who received tacrolimus as prophylaxis were reviewed, with a median age of 9 years (range 0.2–16 years). Twenty-one patients underwent related donor transplants and 20 underwent unrelated donor transplants. All patients received tacrolimus beginning the day prior to transplant at a dose of 0.03 mg/kg/day by continuous i.v. infusion. When clinically possible, patients were switched to oral therapy in two divided doses, at four times the intravenous dose. Tacrolimus levels were monitored twice a week, and dosages adjusted to maintain serum levels 5–15 ng/ml. Common adverse effects included hypomagnesemia (98%), hypertension (49%), nephrotoxicity (34%), and tremors (32%). Less common side-effects (<10% cases) included seizures and hyperglycemia. The median time to anc recovery (anc >500 × 106/l) was 15 days. For the related donor group, the incidence of grade II–IV acute GVHD was 33%, and grade III–IV GVHD 19%. For the unrelated donor group, the incidence of grade II–IV acute GVHD was 55%, and grade III–IV GVHD 30%. Overall, tacrolimus therapy was well tolerated as prophylaxis for acute GVHD in pediatric patients undergoing allogeneic transplantation. Bone Marrow Transplantation (2000) 26, 161–167.

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Authors and Affiliations

  1. Divisions of Hematology/Oncology, Department of Pediatrics, Blood and Marrow Stem Cell Transplantation Program, University of Michigan Medical Center, Ann Arbor, MI, USA

    G Yanik, JE Levine, J Ferrara & RJ Hutchinson

  2. Divisions of Hematology/Oncology, Department of Internal Medicine, Blood and Marrow Stem Cell Transplantation Program, University of Michigan Medical Center, Ann Arbor, MI, USA

    V Ratanatharathorn & J Ferrara

  3. Comprehensive Cancer Center Biostatistics Unit, University of Michigan Medical Center, Ann Arbor, MI, USA

    R Dunn

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  1. G Yanik
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  4. R Dunn
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Yanik, G., Levine, J., Ratanatharathorn, V. et al. Tacrolimus (FK506) and methotrexate as prophylaxis for acute graft-versus-host disease in pediatric allogeneic stem cell transplantation. Bone Marrow Transplant 26, 161–167 (2000). https://doi.org/10.1038/sj.bmt.1702472

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