Combination of CsA, MTX and low-dose, short-course mycophenolate mofetil for GVHD prophylaxis

Lai, Yongrong; Ma, Jie; Schwarzenberger, Paul; Li, W; Cai, Zhengmin; Zhou, Jicheng; Peng, Zhigang; Yang, Jie; Luo, Lin; Luo, Jie; Deng, Donghong; Li, Q; Zhou, Yi; Liang, Junlin

doi:10.1038/bmt.2008.265

Cited by 19 publications

(11 citation statements)

References 37 publications

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“…23 Recently, a multicenter phase 2 study from the Chinese Bone Marrow Transplant Cooperative Group showed that a combination of cyclosporine A, methotrexate, and mycophenolate mofetil for GVHD prophylaxis significantly decreased the risk of acute GVHD compared with historical controls in ISD transplantation. 24,25 This finding is confirmed in our ISD cohort. Thus, the higher incidence of GVHD in the HID group is partly because of the relatively low incidence in the ISD cohort.…”

Section: Discussionsupporting

confidence: 78%

Haploidentical vs identical-sibling transplant for AML in remission: a multicenter, prospective study

Wang

Liu

et al. 2015

Blood

397

316

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Among HID and ISD recipients, the 3-year disease-free survival rate was 74% and 78% (P 5 .34), respectively; the overall survival rate was 79% and 82% (P 5 .36), respectively; cumulative incidences of relapse were 15% and 15% (P 5 .98); and those of the nonrelapse-mortality were 13% and 8% (P 5 .13), respectively. In conclusion, unmanipulated haploidentical HSCT achieves outcomes similar to those of ISD HSCT for AML patients in CR1. Such transplantation was demonstrated to be a valid alternative as postremission treatment of intermediateor high-risk AML patients in CR1 lacking an identical donor. This trial was registered at www.chictr.org as #ChiCTR-OCH-10000940. (Blood. 2015;125(25):3956-3962)

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Section: Discussionsupporting

confidence: 78%

Haploidentical vs identical-sibling transplant for AML in remission: a multicenter, prospective study

Wang

Liu

et al. 2015

Blood

397

316

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“…Lower incidence of GVHD after MSD was attributed to combination of cyclosporine, methotrexate and MMF for GVHD prophylaxis. Prior studies also reported significantly lower rate of GVHD using this combination in recipients of MSD transplant[65,66]. …”

Section: High-dose Post-transplant Cyclophosphamidementioning

confidence: 86%

Overview of the progress on haploidentical hematopoietic transplantation

Farhadfar¹

2016

WJT

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Allogeneic hematopoietic stem cell transplant (HSCT) remains the only potentially curative option for variety of hematologic disorders. Lack of a suitable fully HLA-matched donor limits this option for many patients. Without a suitable related or unrelated HLA-matched donor, umbilical cord blood and haploidentical family members provide a potential source of stem cells. Timely donor availability makes haploidentical donors an attractive alternative donor source. Initial attempts at haploidentical HSCT was associated with significantly increased mortality owing to high rates of graft rejection and severe graft-versus-host disease caused by major donor-recipient HLA-disparity. However, over the past decade, outcomes of haploidentical HSCT have improved significantly. Here, we review the advantages and challenges of haploidentical transplantation. We also discuss new developments to attempt to overcome the challenges to a successful haploidentical transplantation.

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“…11–13,22,23 These differences were likely due to older patient age and higher percentage of HLA-mismatched transplants and CIBMTR high-risk patients in our cohort. Despite this, our PFS and OS estimates are comparable to previous reports.…”

Section: Discussionmentioning

confidence: 90%

Acute GVHD prophylaxis with standard-dose, micro-dose or no MTX after fludarabine/melphalan conditioning

Chen

Zhang

Hahn

et al. 2013

Bone Marrow Transplant

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MTX is a standard component of acute GVHD prophylaxis. However, its use can be limited by toxicity. On the basis of disease risk, we prospectively assigned 132 consecutive patients from January 2005 to February 2011 undergoing first allogeneic hematopoietic cell transplant after conditioning with fludarabine and melphalan to acute GVHD prophylaxis with tacrolimus/MTX (TAC/MTX, N = 22), TAC/micro-dose MTX/mycophenolate mofetil (TAC/μMTX/MMF, N = 78) or TAC/MMF (TAC/MMF, N = 32), to optimize acute GVHD prevention and decrease mortality. The median (range) follow-up was 24 (0.8–60) months. The median patient ages (range) were 37 (23–63), 56 (20–68) and 54 (22–68) years (P < 0.0001) for TAC/MTX, TAC/μMTX/MMF and TAC/MMF, respectively. The 100-day cumulative incidences of grade III–IV acute GVHD were 19, 23 and 49% (P < 0.015), respectively. The cumulative incidences of severe chronic GVHD at 1 year were 38, 29 and 79% (P < 0.001), respectively. Regimen-related toxicities were not significantly different among the three prophylaxis regimens. PFS and OS were equivalent between the TAC/MTX and TAC/μMTX/MMF arms despite significantly older patients in the latter arm, and both had superior PFS and OS than the TAC/MMF arm. Acute GVHD prophylaxis with TAC/μMTX/MMF is as effective as TAC/MTX and superior to TAC/MMF.

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Combination of CsA, MTX and low-dose, short-course mycophenolate mofetil for GVHD prophylaxis

Cited by 19 publications

References 37 publications

Haploidentical vs identical-sibling transplant for AML in remission: a multicenter, prospective study

Haploidentical vs identical-sibling transplant for AML in remission: a multicenter, prospective study

Overview of the progress on haploidentical hematopoietic transplantation

Acute GVHD prophylaxis with standard-dose, micro-dose or no MTX after fludarabine/melphalan conditioning

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