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Graft-versus-host Disease

GVHD prophylaxis with sirolimus-tacrolimus may overcome the deleterious effect on survival of HLA mismatch after reduced-intensity conditioning allo-SCT

Bone Marrow Transplantation volume 50, pages 121–126 (2015)Cite this article

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Abstract

Large studies, mostly based on series of patients receiving CSA/tacrolimus (TKR) plus MTX as immunoprophylaxis, have demonstrated a deleterious effect on survival of the presence of a single mismatch out of eight loci after allogeneic hematopoietic SCT (alloHSCT). We retrospectively analyzed a series of 159 adult patients who received sirolimus(SRL)/TKR prophylaxis after alloHSCT. We compared overall outcomes according to HLA compatibility in A, B, C and DRB1 loci at the allele level: 7/8 (n=20) vs 8/8 (n=139). Donor type was unrelated in 95% vs 70% among 7/8 vs 8/8 pairs, respectively (P=0.01). No significant differences were observed in 3-year OS (68 vs 62%), 3-year EFS (53 vs 49%) and 1-year non-relapse mortality (9 vs 13%). Cumulative incidence of grades II–IV acute GVHD (aGVHD) was significantly higher in 7/8 alloHSCT (68% vs 42%, P<0.001) but no significant differences were found for III-IV aGVHD (4.5% vs 11%), overall (35% vs 53%) and extensive (20% vs 35%) chronic GHVD in 7/8 vs 8/8 subgroups, respectively. In summary, the present study indicates favorable outcomes after alloHSCT using the combination of SRL/TKR combination as GVHD prophylaxis with OS in the range of 55–70%, and non-significant differences in overall outcomes, irrespective of the presence of any mismatches at obligatory loci.

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Acknowledgements

We extend our acknowledgements to the RTICC (RD12/0036/0052). Clínic TPHi, Instituto de Investigaciones Biomédicas August Pi i Sunyer (IDIBAPS), Barcelona; RD12/0036/0046 Jorge Sierra Gil, Hospital de la Santa Creu i Sant Pau, Barcelona; RD12/0036/0071 Jose Antonio Pérez-Simón, Hospital Universitario Virgen del Rocio, Sevilla; RD12/0036/0052.

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Authors and Affiliations

  1. Servicio de Hematología, Hospital Universitario / Instituto de Biomedicina (IBIS)/CSIC, Seville, Spain

    R Parody, T Caballero-Velazquez, F J Marquez-Malaver & J A Perez-Simón

  2. Hospital Clínico de Salamanca, Salamanca, Spain

    L Lopez-Corral, O L Godino, L Vazquez & D Caballero

  3. Hospital Santa Creu i Sant Pau, Barcelona, Spain

    I G Cadenas, R Martino & J Sierra

  4. Hospital Clínico de Valencia, Valencia, Spain

    A P Martinez & C Solano

  5. Hospital Clinic de Barcelona, Barcelona, Spain

    C Martinez

  6. Hospital Vall d’Hebron, Barcelona, Spain

    P Barba & D Valcarcel

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Correspondence to J A Perez-Simón.

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Parody, R., Lopez-Corral, L., Godino, O. et al. GVHD prophylaxis with sirolimus-tacrolimus may overcome the deleterious effect on survival of HLA mismatch after reduced-intensity conditioning allo-SCT. Bone Marrow Transplant 50, 121–126 (2015). https://doi.org/10.1038/bmt.2014.220

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