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Sirolimus, tacrolimus, and low-dose methotrexate as graft-versus-host disease prophylaxis in related and unrelated donor reduced-intensity conditioning allogeneic peripheral blood stem cell transplantation.
Biol Blood Marrow Transplant. 2008 Aug; 14(8):920-6.BB

Abstract

We assessed the combination of sirolimus, tacrolimus, and low-dose methotrexate as acute graft-versus-host disease (aGVHD) prophylaxis after reduced-intensity conditioning (RIC) allogeneic peripheral blood stem cell (PBSC) transplantation from matched related (MRD, n = 46) and unrelated (URD, n = 45) donors. All patients received fludarabine and intravenous busulfan conditioning followed by transplantation of mobilized PBSC. The median time to neutrophil engraftment was 13 days. The cumulative incidence of grade II-IV and III-IV aGVHD were 16% and 7%, respectively. There was no difference in the incidence of aGVHD between MRD and URD cohorts. Two-year cumulative incidence of extensive chronic GVHD (cGVHD) was 40%. Relapse-free survival (RFS) at 2 years was 34%: 21% in MRD and 45% in URD. Overall survival (OS) at 2 years was 59%: 47% in MRD and 67% in URD. High levels (>90%) of donor derived hematopoiesis were achieved in 59% of patients early after transplantation. The addition of sirolimus to tacrolimus and low-dose methotrexate as GVHD prophylaxis following RIC with fludarabine and low-dose intravenous busulfan is associated with rapid engraftment, low rates of aGVHD, and achievement of high levels of donor chimerism.

Authors+Show Affiliations

Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts 02115, USA. Edwin_alyea@dfci.harvard.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

18640576

Citation

Alyea, Edwin P., et al. "Sirolimus, Tacrolimus, and Low-dose Methotrexate as Graft-versus-host Disease Prophylaxis in Related and Unrelated Donor Reduced-intensity Conditioning Allogeneic Peripheral Blood Stem Cell Transplantation." Biology of Blood and Marrow Transplantation : Journal of the American Society for Blood and Marrow Transplantation, vol. 14, no. 8, 2008, pp. 920-6.
Alyea EP, Li S, Kim HT, et al. Sirolimus, tacrolimus, and low-dose methotrexate as graft-versus-host disease prophylaxis in related and unrelated donor reduced-intensity conditioning allogeneic peripheral blood stem cell transplantation. Biol Blood Marrow Transplant. 2008;14(8):920-6.
Alyea, E. P., Li, S., Kim, H. T., Cutler, C., Ho, V., Soiffer, R. J., & Antin, J. H. (2008). Sirolimus, tacrolimus, and low-dose methotrexate as graft-versus-host disease prophylaxis in related and unrelated donor reduced-intensity conditioning allogeneic peripheral blood stem cell transplantation. Biology of Blood and Marrow Transplantation : Journal of the American Society for Blood and Marrow Transplantation, 14(8), 920-6. https://doi.org/10.1016/j.bbmt.2008.05.024
Alyea EP, et al. Sirolimus, Tacrolimus, and Low-dose Methotrexate as Graft-versus-host Disease Prophylaxis in Related and Unrelated Donor Reduced-intensity Conditioning Allogeneic Peripheral Blood Stem Cell Transplantation. Biol Blood Marrow Transplant. 2008;14(8):920-6. PubMed PMID: 18640576.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Sirolimus, tacrolimus, and low-dose methotrexate as graft-versus-host disease prophylaxis in related and unrelated donor reduced-intensity conditioning allogeneic peripheral blood stem cell transplantation. AU - Alyea,Edwin P, AU - Li,Shuli, AU - Kim,Haesook T, AU - Cutler,Corey, AU - Ho,Vincent, AU - Soiffer,Robert J, AU - Antin,Joseph H, PY - 2007/12/31/received PY - 2008/05/30/accepted PY - 2008/7/22/pubmed PY - 2008/11/1/medline PY - 2008/7/22/entrez SP - 920 EP - 6 JF - Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation JO - Biol Blood Marrow Transplant VL - 14 IS - 8 N2 - We assessed the combination of sirolimus, tacrolimus, and low-dose methotrexate as acute graft-versus-host disease (aGVHD) prophylaxis after reduced-intensity conditioning (RIC) allogeneic peripheral blood stem cell (PBSC) transplantation from matched related (MRD, n = 46) and unrelated (URD, n = 45) donors. All patients received fludarabine and intravenous busulfan conditioning followed by transplantation of mobilized PBSC. The median time to neutrophil engraftment was 13 days. The cumulative incidence of grade II-IV and III-IV aGVHD were 16% and 7%, respectively. There was no difference in the incidence of aGVHD between MRD and URD cohorts. Two-year cumulative incidence of extensive chronic GVHD (cGVHD) was 40%. Relapse-free survival (RFS) at 2 years was 34%: 21% in MRD and 45% in URD. Overall survival (OS) at 2 years was 59%: 47% in MRD and 67% in URD. High levels (>90%) of donor derived hematopoiesis were achieved in 59% of patients early after transplantation. The addition of sirolimus to tacrolimus and low-dose methotrexate as GVHD prophylaxis following RIC with fludarabine and low-dose intravenous busulfan is associated with rapid engraftment, low rates of aGVHD, and achievement of high levels of donor chimerism. SN - 1523-6536 UR - https://www.unboundmedicine.com/medline/citation/18640576/Sirolimus_tacrolimus_and_low_dose_methotrexate_as_graft_versus_host_disease_prophylaxis_in_related_and_unrelated_donor_reduced_intensity_conditioning_allogeneic_peripheral_blood_stem_cell_transplantation_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1083-8791(08)00243-7 DB - PRIME DP - Unbound Medicine ER -