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Sirolimus and tacrolimus as immune prophylaxis compared to cyclosporine with or without methotrexate in patients undergoing allogeneic haematopoietic stem cell transplantation for non‐malignant disorders
Author(s) -
Ringdén Olle,
Remberger Mats,
Dahllöf Göran,
GarmingLegert Karin,
Karlsson Helen,
Svenberg Petter,
Uhlin Michael,
Uzunel Mehmet,
Mattsson Jonas
Publication year - 2011
Publication title -
european journal of haematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.904
H-Index - 84
eISSN - 1600-0609
pISSN - 0902-4441
DOI - 10.1111/j.1600-0609.2011.01685.x
Subject(s) - sirolimus , medicine , tacrolimus , cumulative incidence , gastroenterology , transplantation , immunosuppression , graft versus host disease , hematopoietic stem cell transplantation , stem cell , immunology , genetics , biology
For prevention of graft‐versus‐host disease (GVHD), treatment of 24 haematopoietic stem cell transplantation (HSCT) patients with sirolimus and tacrolimus was compared to treatment of matched controls with cyclosporine‐based regimens. The patients mainly had non‐malignant disorders. Two‐thirds of the donors were unrelated, and bone marrow was the most common source of stem cells. Rejection occurred in four patients in the sirolimus group and three in the control group. Donor chimerism for CD3, CD19 and CD33 was similar in the two groups. The cumulative incidence of grade II acute GVHD was 22% in the sirolimus patients and 17% in the controls ( P = 0.78). No patients developed acute GVHD of grades III–IV. The cumulative incidence of chronic GVHD was 25% and 37% in the two groups, respectively ( P = 0.40). Two patients in the sirolimus group developed Epstein–Barr virus lymphoma, and none in the controls. Side effects and toxicity were similar in the two groups. There was no transplant‐related mortality at 5 yr in the sirolimus group, as opposed to 8% in the controls ( P = 0.47). Survival at 5 yr was 95% and 92%. Thus, sirolimus combined with tacrolimus is a promising immunosuppressive regimen in HSCT, also for non‐malignancies, and its efficacy should be confirmed in prospective clinical trials.