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Graft-Versus-Host Disease

Tacrolimus and mycofenolate mofetil as GvHD prophylaxis following nonmyeloablative conditioning and unrelated hematopoietic SCT for adult patients with advanced hematologic diseases

Bone Marrow Transplantation volume 46, pages 747–755 (2011)Cite this article

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Abstract

In the current study, we evaluated a combination of tacrolimus and mycophenolate mofetil (MMF) as GvHD prophylaxis in 50 patients undergoing truly nonmyeloablative (NM; 90 mg/m2 fludarabine, 2 Gy TBI) hematopoietic SCT (HSCT) from unrelated donors. Median patient age was 51 years (range, 25–67 years). After a median follow-up of 1123 days (range, 47–2729 days), 20 patients (40%) are alive and free from disease. The probabilities of 1-, 2- and 3-year survival were 57, 47 and 39%, respectively. Patients who achieved a remission before HSCT had a significantly better OS compared with those who had active disease (P=0.01). The incidences of grade II–IV and III–IV acute GvHD (aGvHD) were 54% (n=27) and 16% (n=8). Remarkably, using tacrolimus and MMF, the median onset of aGvHD occurred distinctly late on day +66 (range, 12–119 days). A total of 46 patients were evaluable for chronic GvHD (cGvHD). Out of these, 26 (56%) patients developed cGvHD, with 16 (34%) of them showing limited and 10 (21%) showing extensive disease. We conclude that the combination of tacrolimus and MMF as post transplant immunosuppression for patients receiving NM unrelated donor HSCT permits stable engraftment and effective prophylaxis for acute and cGvHD. In particular, the occurrence of severe early-onset aGvHD was attenuated.

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Acknowledgements

We thank the staff of the stem cell transplant units KMT and ME10, as well as the staff of the outpatient clinic, for continuous, outstanding patient care and are in debt to the excellent staff of the transplant laboratory.

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  1. Department of Hematology, Oncology and Clinical Immunology, Heinrich Heine-University, Düsseldorf, Germany

    F Zohren, T Schroeder, A Czibere, R Fenk, I Bruns, M Kondakci, C Saure, R Haas & G Kobbe

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Dr Kobbe received research funding and lecture fees from Astellas and Novartis.

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Zohren, F., Schroeder, T., Czibere, A. et al. Tacrolimus and mycofenolate mofetil as GvHD prophylaxis following nonmyeloablative conditioning and unrelated hematopoietic SCT for adult patients with advanced hematologic diseases. Bone Marrow Transplant 46, 747–755 (2011). https://doi.org/10.1038/bmt.2010.167

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