Higher dose of mycophenolate mofetil reduces acute graft-versus-host disease in reduced-intensity conditioning double umbilical cord blood transplantation

Nelli Bejanyan, John Rogosheske, Todd DeFor, Aleksandr Lazaryan, Kelli Esbaum, Shernan Holtan, Mukta Arora, Margaret L. MacMillan, Daniel Weisdorf, Pamala Jacobson, John Wagner, Claudio G. Brunstein

Research output: Contribution to journalArticle

27 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)926-933
Number of pages8
JournalBiology of Blood and Marrow Transplantation
Volume21
Issue number5
DOIs
StatePublished - May 1 2015

Keywords

  • Graft-versus-host disease
  • Mycophenolate mofetil
  • Reduced-intensity conditioning
  • Transplantation
  • Umbilical cord blood

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