期刊
BIOLOGY OF BLOOD AND MARROW TRANSPLANTATION
卷 21, 期 5, 页码 920-925出版社
ELSEVIER SCIENCE INC
DOI: 10.1016/j.bbmt.2015.01.024
关键词
Cord blood transplantation; Graft-versus-host disease; Mycophenolate mofetil; Pharmacokinetics
资金
- Gabrielle's Angel Foundation for Cancer Research
- Memorial Sloan-Kettering Cancer Center Society
- Translational and Integrative Medicine Research Grant
- National Cancer Institute, National Institutes of Health [P01 CA23766]
- Society of Memorial Sloan Kettering Cancer Center
- New York State Empire Clinical Research Investigator Program
Although mycophenolate mofetil (MMF) has replaced corticosteroids as immunosuppression in cord blood transplantation (CBT), optimal MMF dosing has yet to be established. We intensified MMF dosing from every 12 to every 8 hours to augment graft-versus-host disease (GVHD) prophylaxis in double-unit cord blood transplantation (dCBT) and evaluated outcomes according to the total daily MMF dose/kg in 174 dCBT recipients (median age, 39 years; range, 1 to 71) who underwent transplantation for hematologic malignancies. Recipients of an MMF dose <= the median (36 mg/kg/day) had an increased day 100 grade III and IV acute GVHD (aGVHD) incidence compared with patients who received >36 mg/kg/day (24% versus 8%, P = .008). Recipients of <= the median dose who had highly HLA allele (1 to 3 of 6) mismatched dominant units had the highest day 100 grade III and IV aGVHD incidence of 37% (P = .009). This finding was confirmed in multivariate analysis (P = .053). In 83 patients evaluated for mycophenolic acid (MPA) troughs, those with a mean week 1 and 2 trough < .5 mu g/mL had an increased day 100 grade III and IV aGVHD of 26% versus 9% (P = .063), and those who received a low total daily MMF dose and had a low mean week 1 and 2 MPA trough had a 40% incidence (P = .008). Higher MMF dosing or MPA troughs had no impact on engraftment after myeloablation. This analysis supports intensified MMF dosing in milligram per kilogram per day and MPA trough level monitoring early after transplantation in dCBT recipients. (C) 2015 American Society for Blood and Marrow Transplantation.
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