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Prepublished online as a Blood First Edition Paper on May 1, 2003; DOI 10.1182/blood-2003-02-0489. This Article Full Text (PDF) All Versions of this Article: 2003-02-0489v1 102/5/1601    most recent Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Rights and Permissions Citing Articles Citing Articles via HighWire Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Antin, J. H Articles by Soiffer, R. J Search for Related Content PubMed PubMed Citation Articles by Antin, J. H Articles by Soiffer, R. J Social Bookmarking                   What's this? Submitted February 19, 2003 Accepted April 22, 2003 Sirolimus, tacrolimus, and low-dose methotrexate for graft-versus-host disease prophylaxis in mismatched related donor or unrelated donor transplantation Joseph H Antin*, Haesook T Kim, Corey Cutler, Vincent T Ho, Stephanie J Lee, David B Miklos, Ephraim P Hochberg, Catherine J Wu, Edwin P Alyea, and Robert J Soiffer Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA; Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA Department of Biostatistical Science, Dana Farber Cancer Institute, Boston, MA, USA * Corresponding author; email: jantin{at}partners.org. We studied the feasibility and activity of adding sirolimus to tacrolimus and low dose methotrexate as GVHD prophylaxis in recipients of alternative donor transplants. Forty-one patients with hematologic malignancies were conditioned with cyclophosphamide and total body irradiation. Marrow stem cells were from an HLA-A, -B and -DR compatible, unrelated donor (n=26, 68%), a 5/6 antigen matched unrelated donor (n=8, 20%), or from a 5/6 antigen matched family member (n=5, 12%). Therapeutic serum levels of sirolimus were attained in most patients. All evaluable patients engrafted. An absolute neutrophil count of 500/µL was achieved on day +18 (range, 11-32 days). Sustained platelet counts of >20,000/µL were attained on day +29 (range, 14-98 days). Grade 0-I acute GVHD occurred in 75% of patients. Grades II, III, and IV acute GVHD occurred in 13%, 8%, and 5% respectively (total Grade II-IV GVHD 26%). Median survival is 366 days (95% CI 185, not estimable) and actuarial survival at 1 year is 52%. Oral sirolimus is tolerable, adequate blood levels are achievable, and there is a low rate of acute GVHD compared with historical data in this high risk population. This novel agent is worthy of further study in allogeneic transplantation. CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this? This article has been cited by other articles: P. Armand, S. Gannamaneni, H. T. Kim, C. S. Cutler, V. T. Ho, J. Koreth, E. P. Alyea, A. S. LaCasce, E. D. Jacobsen, D. C. Fisher, et al. Improved Survival in Lymphoma Patients Receiving Sirolimus for Graft-Versus-Host Disease Prophylaxis After Allogeneic Hematopoietic Stem-Cell Transplantation With Reduced-Intensity Conditioning J. Clin. Oncol., December 10, 2008; 26(35): 5767 - 5774. [Abstract] [Full Text] [PDF] C. Cutler, K. Stevenson, H. T. Kim, P. Richardson, V. T. Ho, E. Linden, C. Revta, R. Ebert, D. Warren, S. Choi, et al. Sirolimus is associated with veno-occlusive disease of the liver after myeloablative allogeneic stem cell transplantation Blood, December 1, 2008; 112(12): 4425 - 4431. [Abstract] [Full Text] [PDF] R. J. Maggiore, D. L. Cooper, F. M. Foss, W. D. Shlomchik, and S. E. 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