Comparison of immunosuppressant regimens in salvage cord blood transplantation for graft failure after allogeneic hematopoietic stem cell transplantation View Full Text


Ontology type: schema:ScholarlyArticle     


Article Info

DATE

2020-08-20

AUTHORS

Kaito Harada, Shigeo Fuji, Sachiko Seo, Naoyuki Uchida, Toshiro Kawakita, Shingo Yano, Yukiyasu Ozawa, Satoshi Yoshioka, Yasushi Onishi, Yuma Noguchi, Makoto Onizuka, Yoshiko Matsuhashi, Takafumi Kimura, Tatsuo Ichinohe, Yoshiko Atsuta, Seitaro Terakura, Hideki Nakasone

ABSTRACT

Graft failure (GF) is a life-threatening complication after allogeneic stem cell transplantation. Although salvage cord blood transplantation (CBT) is a curative therapy for GF, the optimal immunosuppression after salvage CBT remains unknown. Using nationwide registration data, we compared the transplant outcomes of patients who developed GF and underwent salvage CBT using immunosuppressants, including calcineurin (CNI) alone (n = 177); CNI plus methotrexate (CNI+MTX, n = 150); and CNI plus mycophenolate mofetil (CNI+MMF, n = 161). The CNI+MMF group, in comparison with the CNI+MTX and CNI alone groups, demonstrated better neutrophil recovery at 30 days (62.7 vs. 42.7 vs. 53.1%, P < 0.001); better overall survival (OS) at 12 months (48.4 vs. 33.5 vs. 28.3%, P < 0.001); and lower non-relapse mortality (NRM) at 12 months (35.2 vs. 53.9 vs. 56.5%, P < 0.001). On multivariate analysis, CNI+MMF had the best neutrophil recovery (hazard ratio (HR), 1.71; P < 0.001) and OS (HR, 0.64; P = 0.002) and the lowest NRM (HR, 0.53; P < 0.001). Hemorrhage was relatively less frequent in the CNI+MMF group. CNI+MMF can be a promising immunosuppressant regimen after salvage CBT for GF, with better engraftment and survival outcomes, compared with CNI alone and CNI+MTX. More... »

PAGES

400-410

References to SciGraph publications

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  • Journal

    TITLE

    Bone Marrow Transplantation

    ISSUE

    2

    VOLUME

    56

    Author Affiliations

  • Department of Hematology and Oncology, Tokai University School of Medicine, Isehara, Japan
  • Department of Hematology, Osaka International Cancer Institute, Osaka, Japan
  • Department of Hematology and Oncology, Dokkyo Medical University School of Medicine, Mibu, Japan
  • Department of Hematology, Federation of National Public Service Personnel Mutual Aid Associations Toranomon Hospital, Tokyo, Japan
  • Department of Hematology, National Hospital Organization Kumamoto Medical Center, Kumamoto, Japan
  • Clinical Oncology and Hematology, The Jikei University School of Medicine, Tokyo, Japan
  • Department of Hematology, Japanese Red Cross Nagoya First Hospital, Nagoya, Japan
  • Department of Hematology, Kobe City Medical Center General Hospital, Kobe, Japan
  • Department of Hematology and Rheumatology, Tohoku University Hospital, Sendai, Japan
  • Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
  • Department of Hematology, Kawasaki Medical School Hospital, Kurashiki, Japan
  • Preparation Department, Japanese Red Cross Kinki Block Blood Center, Ibaraki, Japan
  • Department of Hematology and Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
  • Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan
  • Department of Hematology and Oncology, Nagoya University Graduate School of Medicine, Nagoya, Japan
  • Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan
  • Identifiers

    URI

    http://scigraph.springernature.com/pub.10.1038/s41409-020-00999-9

    DOI

    http://dx.doi.org/10.1038/s41409-020-00999-9

    DIMENSIONS

    https://app.dimensions.ai/details/publication/pub.1130205670

    PUBMED

    https://www.ncbi.nlm.nih.gov/pubmed/32820226


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