Clinical Outcomes Using Mycophenolate and Tacrolimus for Graft-versus-Host Disease Prophylaxis in Patients Undergoing Allogeneic Stem Cell Transplant: A Single Institution Experience

Abstract

For recipients of allogeneic hematopoietic stem cell transplant (HSCT), mycophenolate mofetil (MMF) plus tacrolimus combination is mostly used in reduced-intensity (RIC), and nonmyeloablative conditioning (NMAC) whereas methotrexate and tacrolimus combination is preferred in myeloablative conditioning (MAC). We present single institution outcomes in patients undergoing allogeneic HSCT with both MAC and NMAC/RIC regimen using MMF and tacrolimus for graft-versus-host disease (GVHD) prophylaxis. Data from all adult patients who underwent allogeneic HSCT from 2007 to 2017 was collected from Data Back to Centers webbased application of Center for International Blood and Marrow Transplant Research (CIBMTR). A total of 150 patients were included with the mean age of 46.9 years. For the patients who received MAC (n=109), the cumulative incidence of grade II-IV acute GVHD at day 100 was 37%, grade II-IV acute GVHD at one year was 51%, and chronic GVHD at one year was 38%. For the patients who received NMAC/RIC (n=41), the cumulative incidence of grade II-IV acute GVHD at day 100 was 31%, grade II-IV acute GVHD at one year was 28%, and chronic GVHD at one year was 36%. This institutional analysis shows that the combination of MMF and tacrolimus yields acceptable outcomes for the prevention of acute and chronic GVHD.

Galectin‐9 alleviates acute graft‐versus‐host disease after haplo‐hematopoietic stem cell transplantation by regulating regulatory T cell/effector T cell imbalance

“…[1][2][3] The incidence of aGVHD is higher in patients with stem cell transplants from HLA-mismatched and unrelated donors. 2,3 GVHD is characterized by the excessive activation of effector T cells (Teffs), including Th1, Th17, and cytotoxic CD8 + T cells, which can result in the excessive secretion of cytokines, and ultimately induce inflammatory injury to target organs. 4,5 Galectin-9 is a widely expressed soluble molecule that can bind to Tim-3 and negatively regulate the immunity function of Teffs.…”

“…Acute graft‐versus‐host disease (aGVHD) may occur in 30%–50% of patients who undergo transplantation from human leukocyte antigen (HLA)‐matched donors 1–3 . The incidence of aGVHD is higher in patients with stem cell transplants from HLA‐mismatched and unrelated donors 2,3 .…”

“…Acute graft‐versus‐host disease (aGVHD) may occur in 30%–50% of patients who undergo transplantation from human leukocyte antigen (HLA)‐matched donors. 1 , 2 , 3 The incidence of aGVHD is higher in patients with stem cell transplants from HLA‐mismatched and unrelated donors. 2 , 3 GVHD is characterized by the excessive activation of effector T cells (Teffs), including Th1, Th17, and cytotoxic CD8 + T cells, which can result in the excessive secretion of cytokines, and ultimately induce inflammatory injury to target organs.…”