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Graft-Versus-Host Disease

Therapy with mycophenolate mofetil for refractory acute and chronic GVHD

Bone Marrow Transplantation volume 44, pages 739–748 (2009)Cite this article

Abstract

We evaluated the pharmacokinetics and efficacy of oral mycophenolate mofetil (MMF) for treatment of refractory GVHD. In a prospective study of acute GVHD, 9 of 19 patients (47%) had a response and 10 (53%) had no improvement. Survival at 6 and 12 months after the start of MMF was 37 and 16%, respectively. In a retrospective study of acute GVHD, 14 of 29 patients (48%) had a response and 15 (52%) had no improvement. Survival at 6 and 12 months was 55 and 52%, respectively. In a prospective study of chronic GVHD, the cumulative incidence of disease resolution and withdrawal of all systemic immunosuppressive treatment was 9, 17 and 26% at 12, 24 and 36 months, respectively, after starting MMF. Thirteen patients (59%) required additional systemic immunosuppressive treatment for chronic GVHD. Nine of the 42 patients (21%) in the prospective studies discontinued MMF treatment because of toxicity. The area under the curve plasma concentrations of mycophenolic acid seemed to be suboptimal among patients with acute GVHD but not among those with chronic GVHD. MMF can be used effectively for treatment of GVHD.

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Acknowledgements

This research was supported by Grants CA18029, CA15704 and HL36444 from the National Institutes of Health, Department of Health and Human Services, Bethesda, MD, USA.

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Authors and Affiliations

  1. Division of Clinical Research, Fred Hutchinson Cancer Research Center, University of Washington School of Medicine, Seattle, WA, USA

    T Furlong, P Martin, M E D Flowers, T Chauncey, F R Appelbaum, H J Deeg, K Doney, R Witherspoon, B Storer, R Storb & R A Nash

  2. Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA

    P Martin, M E D Flowers, T Chauncey, F R Appelbaum, H J Deeg, K Doney, R Witherspoon, B Storer, R Storb & R A Nash

  3. Institute for Cancer Research and Treatment, Candiolo, Turin, Italy

    F Carnevale-Schianca

  4. University of Alberta, Edmonton, Alberta, Canada

    R Yatscoff

  5. VA Medical Center, Seattle, WA, USA

    T Chauncey

  6. Division of Cellular Therapy, Duke University Medical Center, Durham, NC, USA

    K M Sullivan

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Furlong, T., Martin, P., Flowers, M. et al. Therapy with mycophenolate mofetil for refractory acute and chronic GVHD. Bone Marrow Transplant 44, 739–748 (2009). https://doi.org/10.1038/bmt.2009.76

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