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Substitution of calcineurin inhibitors with corticosteroids after allogeneic hematopoietic cell transplantation

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Abstract

Combination of calcineurin inhibitors (CIs) with short-term methotrexate is a standard prophylactic regimen for graft-versus-host disease (GVHD). However, it is sometimes difficult to continue CIs due to adverse effects, such as renal impairment and fluid overload. In such cases, we replace CIs with corticosteroids, considering that full dose of CIs is equivalent to prednisolone (PSL) at 1 mg/kg. We retrospectively evaluated the clinical significance of replacement of CIs with corticosteroids after allogeneic hematopoietic cell transplantation (HCT). We evaluated 42 patients switched from CIs to corticosteroids within 90 days among the 479 patients who underwent allogeneic HCT at our center between 2007 and 2019. Renal impairment (n = 33), fluid overload (n = 13), and thrombotic microangiopathy (n = 3) were the main reasons for switching. Although creatinine and body weight returned to baseline at 4 weeks after switching, 100-day non-relapse mortality was high (57.1%). Grade II–IV acute GVHD was seen in 10 (24.4%) patients who did not have it before switching treatment (n = 41). In conclusion, CIs were switched to corticosteroids in patients with severe clinical conditions. The incidence of acute GVHD was acceptable. Although the short-term mortality rate was high, improvement of renal function or fluid overload was observed in a certain proportion of the patients.

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All data generated or analyzed during this study are included in this article. Further enquiries can be directed to the corresponding author.

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Acknowledgements

The authors thank the staff of the Hematology ward, Jichi Medical University Saitama Medical Center, for their contribution to daily clinical practice in hematopoietic stem cell transplantation.

Funding

None to declare.

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Authors and Affiliations

  1. Division of Hematology, Jichi Medical University Saitama Medical Center, 1-847 Amanuma, Omiya-ku, Saitama, 330-8503, Japan

    Shimpei Matsumi, Shun-ichi Kimura, Yuhei Nakamura, Masakatsu Kawamura, Junko Takeshita, Shunto Kawamura, Nozomu Yoshino, Yukiko Misaki, Kazuki Yoshimura, Ayumi Gomyo, Yosuke Okada, Yu Akahoshi, Masaharu Tamaki, Machiko Kusuda, Kazuaki Kameda, Hidenori Wada, Aki Tanihara, Miki Sato, Hideki Nakasone, Shinichi Kako & Yoshinobu Kanda

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  1. Shimpei Matsumi
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  2. Shun-ichi Kimura
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  4. Masakatsu Kawamura
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  20. Shinichi Kako
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  21. Yoshinobu Kanda
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Contributions

SM, S-IK, and YK participated in research design, data analysis and the writing of the paper. YN, MK, JT, SK, NY, YM, KY, AG, YO, YA, MT, MK, KK, HW, AT, MS, HN, and SK participated in the performance of research. AT was in charge of accounting management. All authors revised the manuscript and approved the final version to be submitted.

Corresponding author

Correspondence to Yoshinobu Kanda.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This study was approved by the Institutional Review Board of Jichi Medical University Saitama Medical Center (Saitama, Japan). All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Consent to participate

According to the Japanese ethics guideline of clinical studies, we provided information of this retrospective study on the website and enabled patients to be excluded from the study if they do not agree to use their data.

Consent to publish

According to the Japanese ethics guideline of clinical studies, we provided information of this retrospective study on the website and enabled patients to be excluded from the study if they do not agree to use their data.

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Matsumi, S., Kimura, Si., Nakamura, Y. et al. Substitution of calcineurin inhibitors with corticosteroids after allogeneic hematopoietic cell transplantation. Int J Hematol 118, 450–461 (2023). https://doi.org/10.1007/s12185-023-03645-4

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  • DOI: https://doi.org/10.1007/s12185-023-03645-4

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