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Analyzing the clinical outcomes of switching from cyclosporine to tacrolimus in pediatric hematopoietic stem cell transplantation
Author(s) -
Yalcin Koray,
Celen Suna,
Zhumatayev Suleimen,
Daloglu Hayriye,
Pashayev Dayanat,
Öztürkmen Seda,
Uygun Vedat,
Karasu Gulsun,
Yesilipek Akif
Publication year - 2021
Publication title -
clinical transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 76
eISSN - 1399-0012
pISSN - 0902-0063
DOI - 10.1111/ctr.14328
Subject(s) - tacrolimus , medicine , calcineurin , transplantation , nephrotoxicity , hematopoietic stem cell transplantation , immunosuppression , gastroenterology , adverse effect , vomiting , toxicity , surgery
Objective The selection of graft‐vs. ‐host disease (GvHD) prophylaxis is vital for the success of hematopoetic stem cell transplantation (HSCT), and calcineurin inhibitors (CNI) have been used for decades as the backbone of GvHD prophylaxis. The aim of this study is to analyze the results of switching cyclosporine (CSA) to tacrolimus because of acute GvHD, engraftment syndrome (ES), persistent low level of CSA, or various CSA‐associated adverse events in the first 100 days of pediatric HSCT. Materials and Methods This is a retrospective analysis of 192 patients who underwent allogeneic hematopoietic stem cell transplantation at Medicalpark Göztepe and Antalya Hospitals between April 2014 and May 2019 had therapy switched from CSA to tacrolimus‐based immunosuppression within 100 days of transplant. Results The reasons for conversion to tacrolimus were low level of CSA ( n = 70), aGvHD ( n = 63), CSA‐associated neurotoxicity ( n = 15), CSA‐associated nephrotoxicity ( n = 10), hypertension ( n = 10), allergic reactions ( n = 9), ES ( n = 7), CSA‐associated hepatotoxicity ( n = 5), and vomiting ( n = 3). The median day after transplant for conversion to tacrolimus for all patients was day 20 (range 0‐100 days). Response rates to conversion were 38% for GvHD, 86% for neurotoxicity, 50% for nephrotoxicity, 60% for hepatotoxicity, 80% for hypertension, 66% for vomiting, and 57% for ES. Twenty‐nine patients (15%) experienced tacrolimus‐associated toxicities after therapy conversion to tacrolimus. Neurotoxicity emerged as posterior reversible encephalopathy syndrome (PRES), which was the most common toxicity observed after conversion (18/29 patients). Conclusion Our data support the quick conversion to tacrolimus in the condition of persistent low CSA levels with acceptable efficacy and safety. Although both drugs are CNI and share a very similar mechanism of action, the conversion could be preferred especially in specific organ toxicities with special attention for neurotoxicity after conversion.