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Prospective trial of mycophenolate mofetil–cyclosporine A prophylaxis for acute GVHD after G‐CSF stimulated allogeneic bone marrow transplantation with HLA‐identical sibling donors in patients with severe aplastic anemia and hematological malignancies
Author(s) -
Ostronoff Fabiana,
Ostronoff Mauricio,
SoutoMaior Ana Patricia,
Domingues Mariana,
Sucupira Alexandre,
Manso Djenane Almeida,
De Lima Ana Karla Farias,
Monteiro Poliana Gomes,
Florêncio Rodrigo,
Calixto Rodolfo
Publication year - 2009
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/j.1399-0012.2008.00894.x
Subject(s) - medicine , aplastic anemia , gastroenterology , transplantation , methotrexate , bone marrow , hematopoietic stem cell transplantation , cyclophosphamide , graft versus host disease , immunology , surgery , chemotherapy
The combination of methotrexate and cyclosporine A (MTX–CSA) is the standard regimen for the prevention of graft vs. host disease (GVHD) after allogeneic hematopoietic stem cell transplantation (allo‐SCT) from HLA‐identical siblings. Mycophenolate mofetil and CSA (MMF–CSA) combination has been successfully used for GVHD prophylaxis after non‐reduced intensity conditioning (non‐RIC) allo‐SCT with peripheral blood or non‐G‐CSF stimulated bone marrow as stem cell source. We report the results of the first prospective trial of the MMF–CSA combination for acute GVHD prophylaxis in 47 patients after non‐RIC G‐CSF stimulated allo‐BMT (G‐BMT) from HLA‐identical siblings in patients with severe aplastic anemia (SAA) or hematological malignancies. Median age was 28 yr (range, 6–48 yr). Median follow‐up was 22 months. The median time to neutrophil and platelets recovery were nine d (range, 8–17) and 16 d (range, 10–28), respectively. Acute GVHD of grade II–IV and chronic GVHD occurred in 51% and 27%, respectively. Overall survival rates at two yr for patients with SAA and hematological malignancies were 87% and 65%, respectively. The event‐free survival at two yr for patients with hematological malignancies was 76%. We concluded that MMF–CSA appears equivalent to MTX–CSA for GVHD prophylaxis in patients receiving non‐RIC G‐BMT from HLA‐identical siblings, with a tendency for more rapid neutrophil engraftment.