Influence of interruption of oral mycophenolate mofetil for graft-versus-host disease prophylaxis on outcomes after single cord blood transplantation.

Blood cell therapy Pub Date : 2024-04-19 eCollection Date: 2024-05-25 DOI:10.31547/bct-2023-038
Kahori Fukushi, Maki Monna-Oiwa, Seiko Kato, Masamichi Isobe, Seiichiro Kuroda, Yasuhito Nannya, Satoshi Takahashi, Takaaki Konuma
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Abstract

Mycophenolate mofetil (MMF), in combination with a calcineurin inhibitor, is used as the prophylaxis for graft-versus-host disease (GVHD) after allogeneic hematopoietic cell transplantation (HCT). Compared to intravenous methotrexate (MTX), MMF is associated with a lower incidence of mucositis and shorter time for hematopoietic engraftment but comparable incidence of acute GVHD, resulting in the preferred use of MMF for GVHD prophylaxis in elderly patients or those undergoing cord blood transplantation (CBT). Although several studies have evaluated the clinical impact of MTX omission due to toxicity after allogeneic HCT, the impact of oral MMF interruption for GVHD prophylaxis on transplant outcomes remains unclear. Therefore, in this study, we retrospectively analyzed the consecutive data of adult patients who underwent single-unit unrelated CBT and received oral MMF in combination with cyclosporine for GVHD prophylaxis at our hospital. Among the 53 patients, the planned dose of MMF was interrupted in 14 with a median of 19.5 d (range, 3-27 d) of CBT. In multivariate analysis, MMF interruption, which was treated as a time-dependent covariate, was significantly associated with poorer overall survival (hazard ratio [HR], 5.41; 95% confidence interval [CI], 2.03-14.43; P < 0.001) and higher non-relapse mortality (HR, 7.56; 95% CI, 1.99-28.79; P = 0.002). Further studies with larger cohorts are necessary to confirm the clinical significance of oral MMF interruption in GVHD prophylaxis.

Abstract Image

中断口服霉酚酸酯预防移植物抗宿主病对单次脐带血移植结果的影响。
霉酚酸酯(MMF)与钙调磷酸酶抑制剂联合使用,是异基因造血细胞移植(HCT)后预防移植物抗宿主疾病(GVHD)的药物。与静脉注射甲氨蝶呤(MTX)相比,MMF 的粘膜炎发生率较低,造血细胞移植时间较短,但急性 GVHD 的发生率相当,因此在老年患者或接受脐带血移植(CBT)的患者中,MMF 是预防 GVHD 的首选药物。虽然已有多项研究评估了异基因 HCT 后因毒性而停用 MTX 的临床影响,但口服 MMF 预防 GVHD 对移植结果的影响仍不清楚。因此,在本研究中,我们回顾性分析了在我院接受单倍体非亲缘CBT并口服MMF联合环孢素预防GVHD的成年患者的连续数据。在 53 例患者中,有 14 例中断了 MMF 的计划剂量,CBT 的中位时间为 19.5 天(3-27 天)。在多变量分析中,MMF中断(作为时间依赖性协变量)与较差的总生存率(危险比[HR],5.41;95% 置信区间[CI],2.03-14.43;P < 0.001)和较高的非复发死亡率(HR,7.56;95% CI,1.99-28.79;P = 0.002)显著相关。要确认口服MMF在GVHD预防中的临床意义,还需要进行更大规模的队列研究。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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