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Graft-Versus-Host Disease

Tacrolimus instead of cyclosporine used for prophylaxis against graft-versus-host disease improves outcome after hematopoietic stem cell transplantation from unrelated donors, but not from HLA-identical sibling donors: a nationwide survey conducted in Japan

Bone Marrow Transplantation volume 34, pages 331–337 (2004)Cite this article

Summary:

Despite recent advances, graft-versus-host disease (GVHD) remains the main cause of treatment failure for patients undergoing allogeneic hematopoietic stem cell transplantation (HSCT). Tacrolimus (FK506) has been increasingly used in place of cyclosporine (CSP), and several studies have shown that FK506 reduces the incidence of acute GVHD more effectively than does CSP. However, no survival benefits have been demonstrated, and no established consensus exists on the choice of these immunosuppressive agents. To compare a CSP-based and an FK506-based regimen, we performed a large-scale retrospective study by using the data of 1935 patients who underwent HSCT from HLA-identical sibling donors (SIB-HSCT) and 777 patients who underwent HSCT from unrelated donors (UD-HSCT). For patients undergoing UD-HSCT, FK506 significantly reduced the risk of acute GVHD and treatment-related mortality (TRM) without an increase in relapse, thus improving overall survival (OS) (hazard ratio (HR): 2.20, 95% confidence interval (CI): 1.60–3.04, P<0.0001 for grade II–IV acute GVHD; HR: 1.81, 95% CI: 1.32–2.48, P=0.0003 for TRM; HR: 1.62, 95% CI: 1.23–2.14, P=0.0007 for OS). This superiority of FK506 was not observed in SIB-HSCT cases. These findings indicate that the use of FK506 instead of CSP for GVHD prophylaxis is beneficial for patients undergoing UD-HSCT.

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Acknowledgements

This study was conducted as Working Group 10 of the JSHCT. We thank all physicians and staff at the cooperating centers for contributing patient data for this study.

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Authors and Affiliations

  1. Department of Hematology, Nagoya University Graduate School of Medicine, Nagoya, Japan

    M Yanada, N Emi & T Naoe

  2. Hematology Division, Tokyo Metropolitan Komagome Hospital, Tokyo, Japan

    H Sakamaki

  3. Division of Molecular Therapy, Advanced Clinical Research Center, Institute of Medical Science, University of Tokyo, Tokyo, Japan

    S Takahashi

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

    N Hirabayashi

  5. Fifth Department of Internal Medicine, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan

    A Hiraoka

  6. Department of Cell Therapy and Transplantation Medicine, University of Tokyo Hospital, Tokyo, Japan

    Y Kanda

  7. Hematopoietic Stem Cell Transplantation Unit, National Cancer Center Hospital, Tokyo, Japan

    R Tanosaki

  8. Division of Hematology, Department of Medicine, Keio University School of Medicine, Tokyo, Japan

    S Okamoto

  9. Department of Internal Medicine, Hiroshima Red Cross Hospital and Atomic Bomb Survivors Hospital, Hiroshima, Japan

    K Iwato

  10. Department of Preventive Medicine/Biostatistics and Medical Decision Making, Nagoya University Graduate School of Medicine, Nagoya, Japan

    Y Atsuta & N Hamajima

  11. Department of Internal Medicine II, Okayama University Medical School, Okayama, Japan

    M Tanimoto

  12. Department of Cell Transplantation and Regeneration Medicine, Institute of Medical Science, Tokai University School of Medicine, Isehara, Japan

    S Kato

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  1. M Yanada
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  14. M Tanimoto
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  15. S Kato
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Correspondence to M Yanada.

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Yanada, M., Emi, N., Naoe, T. et al. Tacrolimus instead of cyclosporine used for prophylaxis against graft-versus-host disease improves outcome after hematopoietic stem cell transplantation from unrelated donors, but not from HLA-identical sibling donors: a nationwide survey conducted in Japan. Bone Marrow Transplant 34, 331–337 (2004). https://doi.org/10.1038/sj.bmt.1704596

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