Mycophenolate and Tacrolimus for Graft-Versus-Host Disease Prophylaxis for Elderly After Cord Blood Transplantation: A Matched Pair Comparison With Tacrolimus Alone

Abstract

MMF and FK in combination was well tolerated and decreased early NRM possibly by better control of preengraftment immune reactions. Subsequent NRM or disease progression needs to be overcome to further improve survival.

Monitoring mycophenolate mofetil is necessary for the effective prophylaxis of acute GVHD after cord blood transplantation

“…2 An increase in relapse was not shown in the MMF cohort, and the infection rate was almost the same except for HHV-6 reactivation. These data suggest that GVHD prophylaxis using MMF and CNI may be a more advantageous strategy compared with CNI alone.…”

“…1,2 Wide interpatient variability has been reported in the plasma levels of mycophenolate (MPA), an active form of MMF, even after the same MMF exposure; however, few reports have performed therapeutic drug monitoring in CBT. 3 Therefore, we performed a prospective cohort study to (1) determine the correlation between MPA concentration and incidence of severe PES or acute GVHD (aGVHD) after CBT and (2) compare the incidence of these complications with the historical cohort using CNI alone for GVHD prophylaxis after CBT.…”

“…6 Severe PES was defined according to a previous report. 2 Blood samples were collected immediately before and 1, 2 and 4 h after the morning administration of MMF on Day 7 (first week) and Day 21 (third week) after CBT. Total MPA levels in the plasma were measured using the enzyme multiplied immunoassay technique (EMIT) 7 (C 0 , C 1 , C 2 and C 4 , respectively), and C 8 (which means the trough level of the next administration) was assumed to be equal to C 0 values based on results of our preliminary analysis (n = 12 both at the first and third weeks) and other studies.…”

Rapid T‐cell chimerism switch and memory T‐cell expansion are associated with pre‐engraftment immune reaction early after cord blood transplantation

“…Most of the present patients with PIR responded promptly after a short course of steroid treatment, and none experienced graft failure due to HPS. This observation could be attributed to more intensive immunosuppression from adding mycophenolate mofetil to tacrolimus in the majority of patients (Uchida et al, 2011). Although neither the T-cell chimerism nor the memory T-cell counts affected the incidence of acute GVHD, steroid treatment for PIR could suppress the onset of acute GVHD.…”

Prophylactic and therapeutic treatment of graft-versus-host disease in Japan

“…They subsequently reported the merit of the use of Tac instead of CsA to suppress post-CBT immune reactions, including pre-engraftment immune reaction and acute GVHD [82,83]. After demonstrating the feasibility of RIC CBT with CsA or Tac alone for patients aged 55 years and higher [84], Uchida et al [85] added MMF to Tac as GVHD prophylaxis in RIC CBT for elderly patients. They reported a significantly higher engraftment rate (90 vs. 69 %) and a lower incidence of pre-engraftment immune reaction (16 vs. 52 %) in the Tac and MMF group, but the incidences of acute and chronic GVHD were comparable between the two groups.…”