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Blood, 1 April 2007, Vol. 109, No. 7, pp. 3108-3114.
Prepublished online as a Blood First Edition Paper on November 30, 2006; DOI 10.1182/blood-2006-09-046219.
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Submitted September 7, 2006
Accepted November 22, 2006
Extended follow-up of methotrexate-free immunosuppression using sirolimus and tacrolimus in related and unrelated donor peripheral blood stem cell transplantation
Corey Cutler*, Shuli Li, Vincent T. Ho, John Koreth, Edwin Alyea, Robert J. Soiffer, and Joseph H. Antin
Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
Biostatistical Science and Computational Biology, Dana-Farber Cancer Insitute, Boston, MA
* Corresponding author; email: corey_cutler{at}dfci.harvard.edu.
We assessed the combination of sirolimus and tacrolimus without methotrexate after myeloablative allogeneic stem cell transplantation from matched related (MRD, n=53) and unrelated (URD, n=30) donors. All patients received cyclophosphamide and total body irradiation conditioning followed by transplantation of mobilized peripheral blood stem cells. The median time to neutrophil engraftment was 14 days. The median time to platelet engraftment was 12 days. No differences between MRD and URD cohorts was noted. The incidence of grade II-IV and III-IV acute GVHD were 20.5% and 4.8%. The cumulative incidence of chronic GVHD was 59.1%. There were no differences in acute or chronic GVHD incidence between MRD and URD cohorts. The omission of methotrexate was associated with low transplant-related toxicity, with 30 and 100-day treatment-related mortality of 0% and 4.8%. Relapse-free survival at one and two years was 72.3% and 68.5%. Overall survival at one and two years was 77.1% and 72.2%. There were no differences in relapse-free or overall survival between MRD and URD cohorts. The substitution of sirolimus for methotrexate as GVHD prophylaxis is associated with rapid engraftment, a low incidence of acute GVHD, minimal transplant-related toxicity and excellent survival. Differences between MRD and URD cohorts are not evident when effective GVHD prophylaxis is used.
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F. M. Marty, J. Bryar, S. K. Browne, T. Schwarzberg, V. T. Ho, I. V. Bassett, J. Koreth, E. P. Alyea, R. J. Soiffer, C. S. Cutler, et al.
Sirolimus-based graft-versus-host disease prophylaxis protects against cytomegalovirus reactivation after allogeneic hematopoietic stem cell transplantation: a cohort analysis
Blood,
July 15, 2007;
110(2):
490 - 500.
[Abstract]
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