期刊
BIOLOGY OF BLOOD AND MARROW TRANSPLANTATION
卷 21, 期 10, 页码 1776-1782出版社
ELSEVIER SCIENCE INC
DOI: 10.1016/j.bbmt.2015.05.023
关键词
Aplastic anemia; Hematopoietic cell transplantation; Graft-versus-host disease; Immunosuppression; Cyclosporine; Tacrolimus
资金
- National Cancer Institute [U24-CA076518]
- National Heart, Lung, and Blood Institute
- National Institute of Allergy and Infectious Diseases
- National Heart, Lung, and Blood Institute [5U10HL069294]
- Health Resources and Services Administration (HRSA/DHHS) [HHSH250201200016C]
- Office of Naval Research [N00014-13-1-0039, N00014-14-1-0028]
- Actinium Pharmaceuticals
- Allos Therapeutics, Inc.
- Amgen
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. (C) 2015 American Society for Blood and Marrow Transplantation.
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