TY - JOUR
T1 - Higher dose of mycophenolate mofetil reduces acute graft-versus-host disease in reduced-intensity conditioning double umbilical cord blood transplantation
AU - Bejanyan, Nelli
AU - Rogosheske, John
AU - DeFor, Todd
AU - Lazaryan, Aleksandr
AU - Esbaum, Kelli
AU - Holtan, Shernan
AU - Arora, Mukta
AU - MacMillan, Margaret L.
AU - Weisdorf, Daniel
AU - Jacobson, Pamala
AU - Wagner, John
AU - Brunstein, Claudio G.
N1 - Publisher Copyright:
© 2015 American Society for Blood and Marrow Transplantation.
PY - 2015/5/1
Y1 - 2015/5/1
N2 - Mycophenolate mofetil (MMF) is frequently used in hematopoietic cell transplantation (HCT) for graft-versus-host disease (GVHD) prophylaxis and to facilitate engraftment. We previously reported that a higher level of mycophenolic acid can be achieved with an MMF dose of 3 g/day than with 2 g/day. Here, we retrospectively compared clinical outcomes of reduced-intensity conditioning (RIC) double umbilical cord blood (dUCB) HCT recipients receiving cyclosporine A with MMF 2 g (n= 93) versus 3 g (n= 175) daily. Multiple regression analysis adjusted for antithymocyte globulin in the conditioning revealed that MMF 3 g/day led to a 49% relative risk (RR) reduction in grade II to IV acute GVHD rate (RR, .51; 95% confidence interval, .36 to .72; P < .01). However, the higher MMF dose was not protective for chronic GVHD. Additionally, MMF dose was not an independent predictor of neutrophil engraftment or treatment-related mortality at 6 months or 2-year post-transplantation disease relapse, disease-free survival, or overall survival. Higher MMF dose did not increase risk of infectious complications, and infection-related mortality was similar for both MMF doses. Our data indicate that MMF 3 g/day reduces the risk of acute GVHD without affecting other clinical outcomes and should be used for GVHD prophylaxis after RIC dUCB transplantation. -Mycophenolate mofetil 3 g/day dose is associated with 49% relative risk reduction in grade I to IV acute graft-versus-host disease as compared to 2 g/day dose in reduced-intensity-conditioned double umbilical cord blood transplant recipients-Mycophenolate mofetil 3 g/day dose neither had adverse impact on hematopoietic engraftment nor increased the risk of infectious complications-Mycophenolate mofetil 3 g/day does not impact disease relapse, chronic graft-versus-host disease, or survival after reduced-intensity-conditioned double umbilical cord blood transplantation-This study supports the use of mycophenolate mofetil 3 g/day for graft-versus-host disease prophylaxis in the context of reduced-intensity-conditioned double umbilical cord blood transplantation.
AB - Mycophenolate mofetil (MMF) is frequently used in hematopoietic cell transplantation (HCT) for graft-versus-host disease (GVHD) prophylaxis and to facilitate engraftment. We previously reported that a higher level of mycophenolic acid can be achieved with an MMF dose of 3 g/day than with 2 g/day. Here, we retrospectively compared clinical outcomes of reduced-intensity conditioning (RIC) double umbilical cord blood (dUCB) HCT recipients receiving cyclosporine A with MMF 2 g (n= 93) versus 3 g (n= 175) daily. Multiple regression analysis adjusted for antithymocyte globulin in the conditioning revealed that MMF 3 g/day led to a 49% relative risk (RR) reduction in grade II to IV acute GVHD rate (RR, .51; 95% confidence interval, .36 to .72; P < .01). However, the higher MMF dose was not protective for chronic GVHD. Additionally, MMF dose was not an independent predictor of neutrophil engraftment or treatment-related mortality at 6 months or 2-year post-transplantation disease relapse, disease-free survival, or overall survival. Higher MMF dose did not increase risk of infectious complications, and infection-related mortality was similar for both MMF doses. Our data indicate that MMF 3 g/day reduces the risk of acute GVHD without affecting other clinical outcomes and should be used for GVHD prophylaxis after RIC dUCB transplantation. -Mycophenolate mofetil 3 g/day dose is associated with 49% relative risk reduction in grade I to IV acute graft-versus-host disease as compared to 2 g/day dose in reduced-intensity-conditioned double umbilical cord blood transplant recipients-Mycophenolate mofetil 3 g/day dose neither had adverse impact on hematopoietic engraftment nor increased the risk of infectious complications-Mycophenolate mofetil 3 g/day does not impact disease relapse, chronic graft-versus-host disease, or survival after reduced-intensity-conditioned double umbilical cord blood transplantation-This study supports the use of mycophenolate mofetil 3 g/day for graft-versus-host disease prophylaxis in the context of reduced-intensity-conditioned double umbilical cord blood transplantation.
KW - Graft-versus-host disease
KW - Mycophenolate mofetil
KW - Reduced-intensity conditioning
KW - Transplantation
KW - Umbilical cord blood
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UR - http://www.scopus.com/inward/citedby.url?scp=84928125735&partnerID=8YFLogxK
U2 - 10.1016/j.bbmt.2015.01.023
DO - 10.1016/j.bbmt.2015.01.023
M3 - Article
C2 - 25655791
AN - SCOPUS:84928125735
SN - 1083-8791
VL - 21
SP - 926
EP - 933
JO - Biology of Blood and Marrow Transplantation
JF - Biology of Blood and Marrow Transplantation
IS - 5
ER -