Abstract
Combinations of cyclosporine (CSP) with methotrexate (MTX) have been widely used for immunosuppression after allogeneic transplantation for acquired aplastic anemia. We compared outcomes with tacrolimus (TAC)+MTX versus CSP+MTX after transplantation from HLA-identical siblings (SIB) or unrelated donors (URD) in a retrospective cohort of 949 patients with severe aplastic anemia. Study endpoints included hematopoietic recovery, graft failure, acute graft-versus-host disease (GVHD), chronic GVHD, and mortality. TAC+MTX was used more frequently in older patients and, in recent years, in both SIB and URD groups. In multivariate analysis, TAC+MTX was associated with a lower risk of mortality in URD recipients and with slightly earlier absolute neutrophil count recovery in SIB recipients. Other outcomes did not differ statistically between the 2 regimens. No firm conclusions were reached regarding the relative merits of TAC+MTX versus CSP+MTX after hematopoietic cell transplantation for acquired aplastic anemia. Prospective studies would be needed to determine whether the use of TAC+MTX is associated with lower risk of mortality in URD recipients with acquired aplastic anemia.
Original language | English (US) |
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Pages (from-to) | 1776-1782 |
Number of pages | 7 |
Journal | Biology of Blood and Marrow Transplantation |
Volume | 21 |
Issue number | 10 |
DOIs | |
State | Published - Oct 1 2015 |
Bibliographical note
Publisher Copyright:© 2015 American Society for Blood and Marrow Transplantation.
Keywords
- Aplastic anemia
- Cyclosporine
- Graft-versus-host disease
- Hematopoietic cell transplantation
- Immunosuppression
- Tacrolimus