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Acute Leukemia

GvHD prophylaxis after single-unit reduced intensity conditioning cord blood transplantation in adults with acute leukemia

Bone Marrow Transplantation volume 52, pages 1261–1267 (2017)Cite this article

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Abstract

To investigate better GVHD prophylaxis in reduced intensity conditioning umbilical cord blood transplantation (RIC-UCBT), we compared transplant outcomes after UCBT among GvHD prophylaxes using the registry data. We selected patients transplanted for AML or ALL with a calcineurin inhibitor and methotrexate (MTX)/mycophenolate mofetil (MMF) combination. A total of 748 first RIC-UCBT between 2000 and 2012 (MTX+ group, 446, MMF+ group, 302) were included. The cumulative incidence of neutrophil and platelet counts higher than 50 000/μL was significantly better in the MMF+ group (relative risk (RR), 1.55; P<0.001: RR, 1.34; P=0.003, respectively). In multivariate analyses, the risk of grade II–IV and III–IV acute GvHD was significantly higher in the MMF+ group than in the MTX+ group (RR, 1.75; P<0.001: RR, 1.97; P=0.004, respectively). In disease-specific analyses of AML, the risk of relapse of high-risk disease was significantly lower in the MMF+ group (RR, 0.69; P=0.009), whereas no significant difference was observed in the risk of relapse-free and overall survival in high-risk disease. In patients with standard-risk disease, no significant differences were noted in the risk of relapse or survival between the MTX+ and MMF+ groups. Collectively, these results suggest that MMF-containing prophylaxis may be preferable in RIC-UCBT, particularly for high-risk disease.

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Acknowledgements

We thank all the physicians and data managers at the institutes that contributed the valuable data on transplantation to the JSHCT and all the members of the data management committees of the JSHCT. This study was supported in part by a Grant-in-Aid for Scientific Research (KAKENHI 15K09497 to ST) from the Japan Society for the Promotion of Science (JSPS).

Author contributions

ST designed the research, analyzed the data, and wrote the manuscript. YKu, SY, AW, JK, YI and TY analyzed the data and helped write the manuscript. SMiz, NU, YKo, NA, HO, HK, YN, SMiy, MO, and IA collected the patient data. TF, TI and YA supervised the data management. MM and TT designed and supervised the research. All authors reviewed and approved the final version of the manuscript.

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Authors and Affiliations

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

    S Terakura & M Murata

  2. Center for Advanced Medicine and Clinical Research, Nagoya University Hospital, Nagoya, Japan

    Y Kuwatsuka

  3. Department of Hematology and Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan

    S Yamasaki

  4. Department of Hematology, Toranomon Hospital Kajigaya, Kawasaki, Japan

    A Wake

  5. Okinaka Memorial Institute of Medical Research, Tokyo, Japan

    A Wake & N Uchida

  6. Department of Hematology and Oncology, Kyoto University Graduate School of Medicine, Kyoto, Japan

    J Kanda

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

    Y Inamoto & T Fukuda

  8. Department of Internal Medicine, National Hospital Organization Toyohashi Medical Center, Toyohashi, Japan

    S Mizuta

  9. Division of Biostatistics, Tohoku University Graduate School of Medicine, Sendai, Japan

    T Yamaguchi

  10. Department of Hematology, Toranomon Hospital, Tokyo, Japan

    N Uchida

  11. Department of Transfusion Medicine, Tokyo Metropolitan Tama Medical Center, Fuchu, Japan

    Y Kouzai

  12. Division of Hematology-Oncology, Japanese Red Cross Narita Hospital, Narita, Japan

    N Aotsuka

  13. Division of Hematology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan

    H Ogawa

  14. Department of Hematology, Kanagawa Cancer Center, Yokohama, Japan

    H Kanamori

  15. Division of Oncology and Hematology, Department of Internal Medicine, Jikei University School of Medicine, Kashiwa Hospital, Kashiwa, Japan

    K Nishiwaki

  16. Department of Hematology, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan

    S Miyakoshi

  17. Department of Hematology and Oncology, Tokai University School of Medicine, Isehara, Japan

    M Onizuka

  18. The Second Department of Internal Medicine, Nara Medical University Hospital, Kashihara, Japan

    I Amano

  19. Department of Hematology and Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan

    T Ichinohe

  20. Japanese Data Center for Hematopoietic Cell Transplantation, Nagoya, Japan

    Y Atsuta

  21. Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan

    Y Atsuta

  22. Department of Hematology, Hokkaido University Graduate School of Medicine, Sapporo, Japan

    T Teshima

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  1. S Terakura
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for The Japan Society for Hematopoietic Cell Transplantation GVHD working group

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Correspondence to S Terakura.

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Terakura, S., Kuwatsuka, Y., Yamasaki, S. et al. GvHD prophylaxis after single-unit reduced intensity conditioning cord blood transplantation in adults with acute leukemia. Bone Marrow Transplant 52, 1261–1267 (2017). https://doi.org/10.1038/bmt.2017.116

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