Optimal dosage of methotrexate for GVHD prophylaxis in umbilical cord blood transplantation

Adachi, Yoshitaka; Ozeki, Kazutaka; Ukai, Shun; Sagou, Ken; Fukushima, Norishige; Kohno, Akio

doi:10.1007/s12185-019-02598-x

Cited by 9 publications

(5 citation statements)

References 49 publications

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“…In our analyses, among the known factors, only grade II-IV aGVHD was associated with total-TMA. Our group previously reported that high HCT-CI was a risk factor for transplant-related complications with endothelial cell damage including TA-TMA in univariate analysis [23]. This relationship was supported by the analysis of total-TMA.…”

Section: Requirement Of Simple Elevation Of Ldh Regardless Ofmentioning

confidence: 52%

Clinical usefulness of diagnostic criteria for transplant-associated thrombotic microangiopathy

et al. 2020

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One major cause of treatment-related death is transplant-associated thrombotic microangiopathy (TA-TMA). Because of difficulties with diagnosis, many criteria for TA-TMA have been defined. Some patients clinically suspected as TA-TMA have been treated as TA-TMA regardless of TA-TMA criteria fulfillment (clinical-TMA). To examine sensitivities of TA-TMA criteria for clinical-TMA, we retrospectively evaluated 160 patients undergoing allogeneic hematopoietic stem cell transplantation by five major TA-TMA criteria and compared them with clinical-TMA. Cumulative incidences of TA-TMA and non-relapse mortality (NRM) were widely diverse between criteria. Thirty-eight patients fulfilled one or more TA-TMA criteria (total-TMA), and 12 of them fulfilled only one criterion. In patients with total-TMA, thrombocythemia, serum creatinine > 1.5 × baseline, and proteinuria were especially repeatedly observed among TA-TMA criteria. Ninety-two percent of clinical-TMA patients were classified as patients with total-TMA, and high NRM incidences were exhibited in patients with total-TMA even without clinical-TMA. Hematopoietic cell transplant-comorbidity index ≥ 3, nutritional risk index < 83.5, and grade II-IV acute graft-versus-host disease were extracted as independent risk factors for total-TMA. TA-TMA summation criteria that can cover most of clinical-TMA patients and high-risk patients of NRM were useful in clinical settings, and items of TA-TMA criteria previously described might be triggers for applying TA-TMA criteria.

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Section: Requirement Of Simple Elevation Of Ldh Regardless Ofmentioning

confidence: 52%

Clinical usefulness of diagnostic criteria for transplant-associated thrombotic microangiopathy

et al. 2020

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“…También es utilizado en otras enfermedades como artritis psoriásica, dermatomiositis y lupus eritematoso sistémico. El metrotexato tiene un buen uso clínico, pero se ha asociado a una gran variedad de toxicidades hematológicas, malignidades gastrointestinales, mucocutáneas, renales, pulmonares, neuropsiquiátricas y musculoesqueléticas, como anemia, trombocitopenia y leucopenia 14,15 .…”

Section: Tratamiento De Eichunclassified

“…Se usan corticoesteroides tópicos de altas dosis, menos en cara, ingle y axilas, con o sin ciclosporina, antihistamínicos y humectantes, que contienen urea y glicerol para aliviar picazón y prevenir ruptura de la piel. Se debe tener especial preocupación con los corticoesteroides, debido a un mayor riesgo de efectos secundarios e infecciones 14 .…”

Section: Tratamiento De Eichunclassified

Pacientes con enfermedad injerto contra huésped e infecciones asociadas al rechazo de trasplante

Jaramillo¹

2023

cysa

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Introducción: durante muchos años las células madre hematopoyéticas han sido el tratamiento para muchos trastornos hematológicos, pero su eficacia está limitada por la enfermedad injerto contra huésped (EICH); una de las principales complicaciones del trasplante alogénico se encuentra asociado con morbilidad y mortalidad, por lo tanto, la prevención es importante para el éxito del trasplante alogénico. Objetivo: realizar una revisión acerca del reconocimiento clínico de una EICH para brindar el tratamiento correcto y evitar ciertas complicaciones, como infecciones que llevan al rechazo del injerto y ponen en riesgo la calidad de vida del paciente. En la mayoría de los casos las pruebas de laboratorio como biomarcadores y biopsias, son buenos predictores para procesos biológicos o patológicos que confirmen el diagnóstico y establezcan el estadio de la enfermedad. Metodología: se realizó una revisión bibliográfica en bases de datos, tales como Pubmed y ClinicalKey, con base en los siguientes términos MeSH: cirugía, mortalidad, patología, complicaciones, virología. Conclusión: la prevención y tratamiento de esta enfermedad predispone a infecciones y diferentes complicaciones que ponen en riesgo la vida del paciente.

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“…The incidence of PES can be decreased by early immunosuppression after UCBT [ 10 – 12 ], as well as by tocilizumab, the interleukin-6 (IL-6) antibody [ 13 ], which needs further clinical trial and long-term observation for outcomes. In previous studies on UCBT [ 1 , 14 , 15 ], GvHD prophylaxis consisted of cyclosporine A (CsA) or tacrolimus (Tac) in combination with methotrexate (MTX) or corticosteroid has been used in children [ 16 ].…”

Section: Introductionmentioning

confidence: 99%

“…MTX has been reported to decrease the incidence and severity of PES. However, the optimal MTX dosage in UCBT remains not available [ 10 ]. Another treatment, anti-thymocyte globulin (ATG), has been used in UCBT for children with leukemia.…”

Section: Introductionmentioning

confidence: 99%

Impact of posttransplant cyclophosphamide on the outcome of patients undergoing unrelated single-unit umbilical cord blood transplantation for pediatric acute leukemia

Zhan

Liu

et al. 2022

BMC Cancer

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Background Umbilical cord blood transplantation (UCBT) from unrelated donors is one of the successful treatments for acute leukemia in childhood. The most frequent side effect of UCBT is peri-engraftment syndrome (PES), which is directly associated with the greater prevalence of acute and chronic graft-versus-host-disease (aGvHD and cGvHD). In haploidentical stem cell transplantation, posttransplant cyclophosphamide (PTCY) has been demonstrated to be an effective method against GvHD. However, the effects of PTCY as a GvHD prophylactic in UCBT had not been investigated. This study aimed to evaluate the effects of PTCY on the outcomes of UCBT for pediatric acute leukemia. Methods This retrospective study included 52 children with acute leukemia who underwent unrelated single-unit UCBT after myeloablative conditioning regimens. The results from the PTCY and non-PTCY groups were compared. Results The incidence of transplantation-related mortality in non-PTCY and PTCY were 5% and 10% (p = 0.525), respectively. The incidence of relapse in non-PTCY and PTCY were 5% and 23% (p = 0.095), respectively. Second complete remission status (CR2) was an independent risk factor for relapse-free survival (hazard ratio = 9.782, p = 0.001). The odds ratio for sepsis or bacteremia incidence was significantly greater in the PTCY group (9.524, p = 0.017). PTCY group had increased rates of cytomegalovirus activity and fungal infection. The incidence of PES, aGvHD, cGvHD, and hemorrhagic cystitis in the PTCY group was lower than that in the non-PTCY group, although it was not significantly different. Additionally, higher doses of PTCY (29 mg/kg and 40 mg/kg) were associated with lower incidences of aGvHD and severe GvHD (65% and 29%, respectively) than lower doses (93% and 57%, respectively). Engraftment time and graft failure incidence were similar across groups. Conclusion The results support the safety and efficiency of PTCY as part of PES controlling and GvHD prophylaxis in single-unit UCBT for children with acute leukemia. A PTCY dosage of 29 mg/kg to 40 mg/kg appears to be more effective in GvHD prophylaxis for UCBT patients.

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Optimal dosage of methotrexate for GVHD prophylaxis in umbilical cord blood transplantation

Cited by 9 publications

References 49 publications

Clinical usefulness of diagnostic criteria for transplant-associated thrombotic microangiopathy

Clinical usefulness of diagnostic criteria for transplant-associated thrombotic microangiopathy

Pacientes con enfermedad injerto contra huésped e infecciones asociadas al rechazo de trasplante

Impact of posttransplant cyclophosphamide on the outcome of patients undergoing unrelated single-unit umbilical cord blood transplantation for pediatric acute leukemia

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