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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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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DOI: https://doi.org/10.1038/bmt.2017.116
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