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GVHD prophylaxis by tacrolimus and mini-MTX in single-unit CBT: a single institute experience

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Abstract

Tacrolimus (TAC) combined with short-term methotrexate (MTX) is widely used to prevent graft-versus-host disease (GVHD) in cord blood transplantation (CBT). As short-term MTX aggravates mucositis and delays engraftment, we reduced the dose of MTX, as previously reported in the non-CBT setting. Here, we retrospectively analyze outcomes of 20 patients who received CBT from April 2017 to December 2018. All patients received TAC with mini-MTX as GVHD prophylaxis. Mini-MTX was administered at a dose of 5 mg/m2 of MTX on days 1, 3 and 6 after CBT. Median age was 54.5 years. Median follow-up time in surviving patients was 396 days. The primary disease was acute leukemia (n = 12) or malignant lymphoma (n = 8). Three patients and 17 patients received myeloablative and reduced-intensity conditioning, respectively. Rate and median time to engraftment of neutrophils were 90.0% and 20.5 days, respectively. Cumulative incidences of grade II–IV and grade III–IV acute GVHD were 35.0% and 5.0%, respectively. At one year after CBT, the overall survival rate was 80.5%, cumulative incidence of relapse/progression was 15.0%, and non-relapse mortality rate was 5.0%. In conclusion, TAC with mini-MTX may be a promising GVHD prophylaxis regimen in single-unit CBT.

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Acknowledgments

This study was supported by Health, Labour and Welfare Science Grants for Research on Measures for Rare and Intractable Diseases from the Japanese Government.

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Authors and Affiliations

  1. Department of Hematology, Osaka International Cancer Institute, 3-1-69, Otemae, Chuo-Ku, Osaka, 541-8567, Japan

    Shigeo Fuji, Yuma Tada, Ryo Nakata, Keiichi Nakata, Midori Koike, Shuhei Kida, Kazuhito Tsutsumi, Hiroaki Masaie, Hitoshi Yoshida & Jun Ishikawa

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  1. Shigeo Fuji
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  2. Yuma Tada
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  3. Ryo Nakata
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  4. Keiichi Nakata
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  5. Midori Koike
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  6. Shuhei Kida
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  7. Kazuhito Tsutsumi
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  8. Hiroaki Masaie
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  9. Hitoshi Yoshida
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  10. Jun Ishikawa
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Correspondence to Shigeo Fuji.

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Fuji, S., Tada, Y., Nakata, R. et al. GVHD prophylaxis by tacrolimus and mini-MTX in single-unit CBT: a single institute experience. Int J Hematol 111, 278–283 (2020). https://doi.org/10.1007/s12185-019-02762-3

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  • DOI: https://doi.org/10.1007/s12185-019-02762-3

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