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Delayed neutrophil engraftment in cord blood transplantation with intensive administration of mycophenolate mofetil for GVHD prophylaxis

Bone Marrow Transplantation volume 46, pages 148–149 (2011)Cite this article

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In allo-SCT, mycophenolate mofetil (MMF) is increasingly being used for prevention of GVHD because of less mucositis and faster neutrophil engraftment compared with MTX.1 Three-times daily administration of MMF after allo-SCT has been demonstrated to maintain higher plasma levels of the active metabolite, mycophenolic acid (MPA), and possibly result in better clinical outcomes.2, 3, 4 We retrospectively analyzed the effect of MMF dosing on neutrophil engraftment in single-unit cord blood transplantation (s-CBT) and unrelated BMT.

A total of 45 patients who received allo-SCT using MMF between November 2004 and November 2009 were studied. The patient characteristics are shown in Table 1. All patients received allo-SCT as a primary setting. MMF was administered orally for GVHD prophylaxis in combination with tacrolimus from 4 to 6 h after allo-SCT from day 0 to day 30, and then the dose tapered depending on individual risk factors for GVHD as described previously.5 Regardless of the stem cell source, MMF was administered twice a day (b.i.d.) at a dose of 17.5 mg/kg (range 12.2–26.0 mg/kg, maximum 3000 mg/day) or thrice a day (t.i.d.) at a fixed dose of 1000 mg (median 17.5 mg/kg, range 10.0–22.7 mg/kg, total 3000 mg/day). Neutrophil engraftment was defined as the first of two consecutive days with an ANC of >0.5 × 109/l. Acute GVHD was graded according to the consensus grading scale. The cumulative incidence was calculated for neutrophil engraftment and acute GVHD by treating death as a competing event. All descriptive data were analyzed using the statistical package Prism 5.0 (GraphPad Software, San Diego, CA, USA).

Table 1 Patient characteristics and engraftment
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Acknowledgements

We are very grateful to the patients who participated in this study. We also thank all the nurses, other medical staff of the stem cell transplantation unit, and physicians of Hematology Division at Kobe University Hospital for taking care of our patients in this study. This work was supported in part by Grants-in Aid for scientific research from the Ministry of Health, Welfare, and Labor in Japan.

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  1. Division of Hematology, Department of Medicine, Kobe University Graduate School of Medicine, Kobe, Japan

    A Okamura, M Shimoyama, S Ishii, K Wakahashi, N Asada, H Kawano, Y Kawamori, S Nishikawa, K Minagawa, Y Katayama & T Matsui

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  1. A Okamura
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  2. M Shimoyama
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  3. S Ishii
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Correspondence to A Okamura.

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Okamura, A., Shimoyama, M., Ishii, S. et al. Delayed neutrophil engraftment in cord blood transplantation with intensive administration of mycophenolate mofetil for GVHD prophylaxis. Bone Marrow Transplant 46, 148–149 (2011). https://doi.org/10.1038/bmt.2010.59

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