Cyclosporine A and mycophenolate mofetil vs cyclosporine A and methotrexate for graft-versus-host disease prophylaxis after stem cell transplantation from HLA-identical siblings

Bone Marrow Transplant. 2005 Jun;35(11):1089-93. doi: 10.1038/sj.bmt.1704956.

Abstract

The combination of Cyclosporin A (CSA) and Methotrexate (MTX) is considered to be the standard regimen for the prevention of graft-versus-host disease (GVHD) after stem cell transplantation (SCT) from HLA-identical siblings. Mycophenolate Mofetil (MMF) has been widely used for GVHD prophylaxis after nonmyeloablative SCT, but experience following myeloablative therapy is still limited. We retrospectively compared CSA/MTX and CSA/MMF in 93 patients (median age 35 years, range 17-59 years, male subjects 48, female subjects 45) with acute myeloid leukemia (n=33), myelodysplastic syndrome (MDS) (n=3), acute lymphoblastic leukemia (ALL) (n=20) or chronic myeloid leukemia (n=37) who received CSA/MMF (n=26) or CSA/MTX (n=67) as GVHD prophylaxis following high-dose therapy and allogeneic SCT from HLA-identical siblings. No statistically significant differences were found in overall survival, relapse rate, treatment-related mortality and acute or chronic GVHD. Time to myeloid recovery was significantly shorter in patients who received CSA/MMF. We conclude that the combination of CSA/MMF appears equivalent to CSA/MTX for GVHD prophylaxis in patients receiving conventional-intensity SCT from HLA-identical siblings.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Cyclosporine / administration & dosage*
  • Female
  • Graft vs Host Disease / prevention & control*
  • HLA Antigens
  • Histocompatibility
  • Histocompatibility Testing
  • Humans
  • Immunosuppressive Agents / administration & dosage*
  • Leukemia / mortality
  • Leukemia / therapy
  • Living Donors
  • Male
  • Methotrexate / administration & dosage*
  • Middle Aged
  • Mycophenolic Acid / administration & dosage*
  • Mycophenolic Acid / analogs & derivatives*
  • Myelodysplastic Syndromes / mortality
  • Myelodysplastic Syndromes / therapy
  • Recurrence
  • Retrospective Studies
  • Siblings
  • Stem Cell Transplantation / methods*
  • Time Factors
  • Transplantation Conditioning
  • Transplantation, Homologous / methods
  • Treatment Outcome

Substances

  • HLA Antigens
  • Immunosuppressive Agents
  • Cyclosporine
  • Mycophenolic Acid
  • Methotrexate