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Background. Although the use of methotrexate (MTX) and mycophenolate mofetil (MMF) for prophylaxis of graft-versus-host disease (GVHD) in allogeneic hematopoietic stem cell transplantation (allo-HSCT) was compared in a large number of studies, the published results are contradictory. This fact provides ground for the present retrospective single-center trial comparing these two approaches in GVHD prophylaxis. Materials & Methods. The present study included 294 allo-HSC recipients with MTX prophylaxis and 172 alloHSC recipients with MMF prophylaxis. 36 % of patients underwent matched related donor transplantation, and 64 % of patients received matched unrelated donor transplantation. Results. Univariate and multivariate analyses showed that probability of acute grade 2–4 GVHD was 36 % vs. 39 % (hazard ratio [HR] 1.297; 95% confi dence interval [95% CI] 0.931–1.795; p = 0.122), grade 3–4 GVHD was 21 % vs. 25 % (HR 1.472; 95% CI 0.951–2.256; p = 0.05), and probability of chronic GVHD was 52 % vs. 55 % (HR 0.978; 95% CI 0.951–1.406; p = 0.91). In the MTX and MMF groups there were no signifi cant diff erences in transplantation mortality (HR 1.173; 95% CI 0.797–1.708; p = 0.43), relapse incidence (HR 1.034; 95% CI 0.743–1.428; p = 0.84), overall survival (HR 1.087; 95% CI 0.825–1.433; p = 0.55), event-free survival (HR 1.108; 95% CI 0.854–1.437; p = 0.43), disease and GVHD free survival (HR 1.065; 95% CI 0.845–1.343; p = 0.59). Engraftment occurred earlier when MMF was used (p = 0.035). Administration of MMF instead of MTX was associated with lower probability of grade 3–4 toxic hepatitis (7 % vs. 31 %; p < 0.0001) and grade 3–4 mucositis (23 % vs. 45 %; p = 0.0002). 44 И.С. Моисеев и др. КЛИНИЧЕСКАЯ ОНКОГЕМАТОЛОГИЯ Заключение. Профилактика РТПХ с использованием ММФ сравнима по своей эффективности с МТХ, при этом ММФ обладает лучшим профилем безопасности в виде снижения вероятности тяжелой печеночной токсичности и мукозита. Ключевые слова: трансплантация аллогенных гемопоэтических стволовых клеток, реакция «трансплантат против хозяина», профилактика, метотрексат, микофенолата мофетил. Получено: 23 мая 2018 г. Принято в печать: 4 декабря 2018 г. Для переписки: Иван Сергеевич Моисеев, канд. мед. наук, ул. Льва Толстого, д. 6/8, Санкт-Петербург, Российская Федерация, 197022; тел.: +7(812)338-55-03; e-mail: moisiv@mail.ru Для цитирования: Моисеев И.С., Тараканова Ю.А., Алянский А.Л. и др. Сравнительное исследование микофенолата мофетила и метотрексата в профилактике реакции «трансплантат против хозяина» при родственных и неродственных аллоТГСК у взрослых. Клиническая онкогематология. 2019;12(1):43–50. DOI: 10.21320/2500-2139-2019-12-1-43-50 Conclusion. The effi cacy of GVHD prophylaxis using MMF is comparable with that of MTX, but MMF is associated with a better safety profi le due to reduced incidence of severe liver toxicity and mucositis.

kliničeskaâ onkogematologiâ

Comparative Study of Mycophenolate Mofetil and Methotrexate in Graft-Versus-Host Disease Prophylaxis in Adult Recipients of Related and Unrelated Allo-HSCT