A retrospective comparison of tacrolimus versus cyclosporine with methotrexate for immunosuppression after allogeneic hematopoietic cell transplantation with mobilized blood cells.

Publication Type:

Journal Article

Source:

Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation, Volume 17, Issue 7, p.1088-92 (2011)

Keywords:

2011, Adolescent, Adult, Aged, Calcineurin, Center-Authored Paper, Child, Child, Preschool, Clinical Research Division, Cyclosporine, Drug Evaluation, Drug Therapy, Combination, Female, Graft vs Host Disease, Granulocyte Colony-Stimulating Factor, Hematologic Neoplasms, Hematopoietic Stem Cell Mobilization, Humans, Immunosuppressive Agents, Infant, Kaplan-Meier Estimate, Male, methotrexate, Middle Aged, Peripheral Blood Stem Cell Transplantation, Proportional Hazards Models, Research Trials Office Core Facility - Biostatistics Service, Retrospective Studies, September 2011, Severity of Illness Index, Shared Resources, Standard of Care, Tacrolimus, Transplantation Conditioning, Transplantation, Homologous, Treatment Outcome

Abstract:

This retrospective study was performed to compare results with tacrolimus versus cyclosporine in combination with methotrexate for immunosuppression after allogeneic hematopoietic cell transplantation (HCT) with granulocyte colony-stimulating factor-mobilized blood cells. The cohort included 456 consecutive patients who received first allogeneic T cell-replete HCT with mobilized blood cells from related or unrelated donors after high-intensity conditioning for treatment of hematologic malignancies. Study endpoints included grades II-IV acute graft-versus-host disease (aGVHD), grades III-IV aGVHD, chronic GVHD (cGVHD), end of treatment for cGVHD, overall mortality, disease-free survival (DFS), recurrent malignancy, and nonrelapse mortality (NRM). Adjusted multivariate Cox regression analysis showed no statistically significant differences between tacrolimus and cyclosporine for any of the endpoints tested. Although the size of the cohort is not sufficient to exclude clinically meaningful differences in outcomes, these results support the continued use of cyclosporine at centers that have not adopted tacrolimus as the standard of care after HCT with mobilized blood cells after high-intensity conditioning regimens. A larger registry study should be performed to provide more definitive information comparing outcomes with the 2 calcineurin inhibitors.