Mycophenolate mofetil for the prophylaxis of acute graft-versus-host disease in stem cell transplant recipients

Kiehl, M. G.; Schäfer-Eckart, K.; Kröger, M.; Bornhäuser, Martin; Basara, Nadežda; Blau, IW; Kienast, Joachim; Fauser, AA; Ehninger, Gerhard; Armstrong, Victor W.; Shipkova, Maria

doi:10.1016/s0041-1345(02)03489-9

Cited by 29 publications

(29 citation statements)

References 17 publications

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“…In contrast to our study, where the majority of patients received mobilized allogeneic peripheral blood stem cells, the patients reported by Bolwell et al 19 were transplanted with unmanipulated bone marrow. In line with our findings, Kiehl 1 and Bolwell 19 did not see significant differences in the rate and severity of acute or chronic GVHD. Taken together, cumulative evidence suggests that the combination of CSA and MMF is at least as effective as the standard regimen of CSA and MTX in the prevention of GVHD after hematopoietic stem cell transplantation, while it offers a markedly reduced toxicity profile.…”

Section: Discussionsupporting

confidence: 91%

“…[20][21][22] Clinical trials have suggested that there may be a benefit of CSA/MMF after myeloablative conditioning as well. 1,[17][18][19] However, as a limitation of these studies, they included limited patient numbers and very heterogeneous patient groups in terms of the risk to develop acute or chronic GVHD. We therefore focused our retrospective single center study on 93 patients with acute and chronic leukemias who received unmanipulated bone marrow or G-CSF-mobilized peripheral blood stem cell grafts from HLA-identical siblings.…”

Section: Discussionmentioning

confidence: 99%

“…1 Intensive immunosuppression using in vivo or in vitro T-cell-depleting agents reduces GVHD but results in a high rate of graft failure and relapse, whereas less intense regimens result in a higher risk of severe acute and chronic GVHD. [2][3][4][5][6][7] The combination of Cyclosporin A (CSA) and Methotrexate (MTX) has been shown to be an effective regimen and has become the standard therapy for the prevention of GVHD.…”

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confidence: 99%

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Cyclosporine A and Mycophenolate Mofetil vs Cyclosporine A and Methotrexate for graft-versus-host disease prophylaxis after stem cell transplantation from HLA-identical siblings

Neumann

Graef

Tapprich

et al. 2005

Bone Marrow Transplant

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Summary:The combination of Cyclosporin A (CSA) and Methotrexate (MTX) is considered to be the standard regimen for the prevention of graft-versus-host disease (GVHD) after stem cell transplantation (SCT) from HLA-identical siblings. Mycophenolate Mofetil (MMF) has been widely used for GVHD prophylaxis after nonmyeloablative SCT, but experience following myeloablative therapy is still limited. We retrospectively compared CSA/MTX and CSA/MMF in 93 patients (median age 35 years, range 17-59 years, male subjects 48, female subjects 45) with acute myeloid leukemia (n ¼ 33), myelodysplastic syndrome (MDS) (n ¼ 3), acute lymphoblastic leukemia (ALL) (n ¼ 20) or chronic myeloid leukemia (n ¼ 37) who received CSA/MMF (n ¼ 26) or CSA/MTX (n ¼ 67) as GVHD prophylaxis following high-dose therapy and allogeneic SCT from HLA-identical siblings. No statistically significant differences were found in overall survival, relapse rate, treatment-related mortality and acute or chronic GVHD. Time to myeloid recovery was significantly shorter in patients who received CSA/MMF. We conclude that the combination of CSA/MMF appears equivalent to CSA/MTX for GVHD prophylaxis in patients receiving conventional-intensity SCT from HLA-identical siblings.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Cyclosporine A and Mycophenolate Mofetil vs Cyclosporine A and Methotrexate for graft-versus-host disease prophylaxis after stem cell transplantation from HLA-identical siblings

Neumann

Graef

Tapprich

et al. 2005

Bone Marrow Transplant

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“…In line with several studies comparing the introduction of MMF instead of MTX as GVHD prophylaxis in Table 2 Cause of death according to the GVHD prophylaxis allo-HSCT, 5,10,21 in this retrospective study we report a similar incidence of GVHD and possibly a somewhat improved toxicity profile in favor of the CsA/MMF combination. It is important to note, however, that earlier studies comparing the impact of such combinations on the toxicity profile, the incidence of GVHD and transplantrelated mortality, had considerable limitations.…”

Section: Discussionsupporting

confidence: 89%

“…As reported by Kiehl et al 21 and Bolwell et al, 10 we found a lower rate of severe mucositis in patients who received CsA/MMF GVHD prophylaxis. Especially, relevant is the absence of grade 4 oral mucositis in this group.…”

Section: Discussionsupporting

confidence: 85%

MTX or mycophenolate mofetil with CsA as GVHD prophylaxis after reduced-intensity conditioning PBSCT from HLA-identical siblings

Piñana

Valcárcel

Fernández‐Avilés

et al. 2010

Bone Marrow Transplant

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Mycophenolate mofetil (MMF) in combination with CsA seems to lead to earlier post transplant hematological recovery and less mucositis than MTX, with a similar incidence of GVHD. In this study we analyzed the post transplant outcomes of two cohorts of patients who underwent an HLA-identical sibling reduced intensity conditioning transplantation (allo-RIC) with GVHD prophylaxis consisting of CsA in combination with either MMF or a short course of MTX. We included 145 consecutive allo-RIC transplants performed between April 2000 and August 2007. The median follow-up for survivors was 41 months (4-105 months). The study group included 91 males. Median age was 55 years (range 18-71 years). Diagnoses included myeloid (n ¼ 65) and lymphoid (n ¼ 80) malignancies. GVHD prophylaxis consisted of CsA/MMF in 52 and CsA/MTX in 93 patients. The conditioning regimen was based on fludarabine in combination with BU (n ¼ 59) or melphalan (n ¼ 86). The occurrence of grade 2-4 mucositis was higher in the CsA/MTX group than in the CsA/MMF group (57 vs 23%, P ¼ 0.001). The cumulative incidence of acute and chronic GVHD was similar, 48 vs 50% and 71 vs 68%, respectively (P40.7). The 2-year relapse and OS were similar in the CsA/MTX and CsA/MMF groups (29 vs 21%, P ¼ 0.3 and 52 vs 51%, P ¼ 0.7, respectively). Our results support further prospective studies comparing the use of the CsA/MMF combination with CsA/MTX as GVHD prophylaxis in HLA-identical sibling donor allo-RIC recipients.

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Mycophenolate mofetil versus methotrexate for prevention of graft-versus-host disease in people receiving allogeneic hematopoietic stem cell transplantation

Kharfan‐Dabaja

Mhaskar

Reljic

et al. 2014

Cochrane Database of Systematic Reviews

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Mycophenolate mofetil for the prophylaxis of acute graft-versus-host disease in stem cell transplant recipients

Cited by 29 publications

References 17 publications

Cyclosporine A and Mycophenolate Mofetil vs Cyclosporine A and Methotrexate for graft-versus-host disease prophylaxis after stem cell transplantation from HLA-identical siblings

Cyclosporine A and Mycophenolate Mofetil vs Cyclosporine A and Methotrexate for graft-versus-host disease prophylaxis after stem cell transplantation from HLA-identical siblings

MTX or mycophenolate mofetil with CsA as GVHD prophylaxis after reduced-intensity conditioning PBSCT from HLA-identical siblings

Mycophenolate mofetil versus methotrexate for prevention of graft-versus-host disease in people receiving allogeneic hematopoietic stem cell transplantation

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