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Mycophenolate-based graft versus host disease prophylaxis is not inferior to methotrexate in myeloablative-related donor stem cell transplantation.
Am J Hematol. 2015 May; 90(5):392-9.AJ

Abstract

We retrospectively reviewed 242 patients who received related donor myeloablative peripheral blood hematopoietic cell transplantation. We compared patients who received mycophenolate (MMF)/cyclosporine (CSA) (n = 71), to historical controls who received methotrexate (MTX)/CSA (n = 172). There were no differences in overall survival, nonrelapse mortality, and relapse. The MMF/CSA group had significantly faster neutrophil and platelet engraftment: medians of 13 versus 18 days and 10 versus 14 days, respectively (P = 0.001). The cumulative incidence of acute graft versus host disease (GVHD) (Grades, 2-4) was significantly lower in the MMF/CSA group (45.1 vs. 74.4%, P < 0.001). The MMF/CSA group showed a lower incidence of skin (51.5 vs. 72.1%, P < 0.001) and liver acute GVHD (11.3 vs. 54.2%, P < 0.001) and a higher incidence of lung (42.2 vs. 19.0%, P = 0.045), eye (59.7 vs. 30.1%, P < 0.001), and mouth (72.8 vs. 56.4%, P = 0.001) chronic GVHD but only eye chronic GVHD was confirmed in propensity score matching (PSM) analysis. The incidence of cytomegalovirus (CMV) viremia was higher in the MMF/CSA group (55.8 vs. 39.6%, P < 0.001) but this was not confirmed in PSM analysis. MMF/CSA was identified as an independent favorable factor for acute GVHD (P < 0.001, hazard ratio, 0.41) but as a possible adverse risk factor for CMV viremia as this was not found to be statistically significant in PSM analysis. MMF/CSA in myeloablative matched related donor peripheral blood stem cell transplant is not inferior as GVHD prophylaxis in comparison with MTX/CSA and is associated with faster engraftment but a potentially higher risk of CMV viremia.

Authors+Show Affiliations

Allogeneic Blood and Marrow Transplant Program, Princess Margaret Cancer Center, University of Toronto, Canada.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

25615933

Citation

Hamad, Nada, et al. "Mycophenolate-based Graft Versus Host Disease Prophylaxis Is Not Inferior to Methotrexate in Myeloablative-related Donor Stem Cell Transplantation." American Journal of Hematology, vol. 90, no. 5, 2015, pp. 392-9.
Hamad N, Shanavas M, Michelis FV, et al. Mycophenolate-based graft versus host disease prophylaxis is not inferior to methotrexate in myeloablative-related donor stem cell transplantation. Am J Hematol. 2015;90(5):392-9.
Hamad, N., Shanavas, M., Michelis, F. V., Uhm, J., Gupta, V., Seftel, M., Kuruvilla, J., Lipton, J. H., Messner, H. A., & Kim, D. D. (2015). Mycophenolate-based graft versus host disease prophylaxis is not inferior to methotrexate in myeloablative-related donor stem cell transplantation. American Journal of Hematology, 90(5), 392-9. https://doi.org/10.1002/ajh.23955
Hamad N, et al. Mycophenolate-based Graft Versus Host Disease Prophylaxis Is Not Inferior to Methotrexate in Myeloablative-related Donor Stem Cell Transplantation. Am J Hematol. 2015;90(5):392-9. PubMed PMID: 25615933.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Mycophenolate-based graft versus host disease prophylaxis is not inferior to methotrexate in myeloablative-related donor stem cell transplantation. AU - Hamad,Nada, AU - Shanavas,Mohamed, AU - Michelis,Fotios V, AU - Uhm,Jieun, AU - Gupta,Vikas, AU - Seftel,Matthew, AU - Kuruvilla,John, AU - Lipton,Jeffrey H, AU - Messner,Hans A, AU - Kim,Dennis Dong Hwan, Y1 - 2015/04/08/ PY - 2014/06/15/received PY - 2015/01/13/revised PY - 2015/01/15/accepted PY - 2015/1/24/entrez PY - 2015/1/24/pubmed PY - 2015/6/24/medline SP - 392 EP - 9 JF - American journal of hematology JO - Am J Hematol VL - 90 IS - 5 N2 - We retrospectively reviewed 242 patients who received related donor myeloablative peripheral blood hematopoietic cell transplantation. We compared patients who received mycophenolate (MMF)/cyclosporine (CSA) (n = 71), to historical controls who received methotrexate (MTX)/CSA (n = 172). There were no differences in overall survival, nonrelapse mortality, and relapse. The MMF/CSA group had significantly faster neutrophil and platelet engraftment: medians of 13 versus 18 days and 10 versus 14 days, respectively (P = 0.001). The cumulative incidence of acute graft versus host disease (GVHD) (Grades, 2-4) was significantly lower in the MMF/CSA group (45.1 vs. 74.4%, P < 0.001). The MMF/CSA group showed a lower incidence of skin (51.5 vs. 72.1%, P < 0.001) and liver acute GVHD (11.3 vs. 54.2%, P < 0.001) and a higher incidence of lung (42.2 vs. 19.0%, P = 0.045), eye (59.7 vs. 30.1%, P < 0.001), and mouth (72.8 vs. 56.4%, P = 0.001) chronic GVHD but only eye chronic GVHD was confirmed in propensity score matching (PSM) analysis. The incidence of cytomegalovirus (CMV) viremia was higher in the MMF/CSA group (55.8 vs. 39.6%, P < 0.001) but this was not confirmed in PSM analysis. MMF/CSA was identified as an independent favorable factor for acute GVHD (P < 0.001, hazard ratio, 0.41) but as a possible adverse risk factor for CMV viremia as this was not found to be statistically significant in PSM analysis. MMF/CSA in myeloablative matched related donor peripheral blood stem cell transplant is not inferior as GVHD prophylaxis in comparison with MTX/CSA and is associated with faster engraftment but a potentially higher risk of CMV viremia. SN - 1096-8652 UR - https://www.unboundmedicine.com/medline/citation/25615933/Mycophenolate_based_graft_versus_host_disease_prophylaxis_is_not_inferior_to_methotrexate_in_myeloablative_related_donor_stem_cell_transplantation_ L2 - https://doi.org/10.1002/ajh.23955 DB - PRIME DP - Unbound Medicine ER -