Tacrolimus and minidose methotrexate for prevention of acute graft-versus-host disease after HLA-mismatched marrow or blood stem cell transplantation

D. Przepiorka, I. Khouri, C. Ippoliti, N. T. Ueno, R. Mehra, M. Körbling, S. Giralt, J. Gajewski, H. Fischer, M. Donato, K. Cleary, D. Claxton, K. W. Chan, I. Braunschweig, K. Van Besien, B. S. Andersson, P. Anderlini, R. Champlin

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58 Scopus citations

Abstract

Thirty adults with leukemia or lymphoma transplanted with marrow or blood stem cells from 1-antigen mismatched related donors received tacrolimus and minidose methotrexate to prevent acute graft-versus-host disease (GVHD). The group had a median age of 42 years (range 18-56 years). Twenty-seven patients had advanced disease, and 13 were resistant to conventional therapy. Tacrolimus was administered at 0.03 mg/kg/day i.v. by continuous infusion from day -2, converted to oral at four times the i.v. dose following engraftment, and continued to day 180 post-transplant. Methotrexate 5 mg/m2 was given i.v. on days 1, 3, 6 and 11. Mild nephrotoxicity was common before day 100; 69% of patients had a doubling of creatinine, 56% had a peak creatinine greater than 2 mg/dl, and two patients were dialyzed. Other toxicities prior to day 100 thought to be related to tacrolimus included hypertension (45%), hyperkalemia (17%), hyperglycemia (14%), seizures (13%), headache (3%) and hemolytic uremic syndrome (3%). Grades 2-4 GVHD occurred in 59% (95% CI, 38-70%), and grades 3-4 GVHD in 17% (95% CI, 1-32%). Overall survival at 1 year was 29% (95% CI, 12-45%). We conclude that tacrolimus and minidose methotrexate is active post-transplant immunosuppression for patients with 1-antigen mismatched donors.

Original languageEnglish (US)
Pages (from-to)763-768
Number of pages6
JournalBone Marrow Transplantation
Volume24
Issue number7
DOIs
StatePublished - Jan 1 1999
Externally publishedYes

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Keywords

  • Graft-versus-host disease
  • Mismatched marrow transplantation
  • Tacrolimus

ASJC Scopus subject areas

  • Hematology
  • Transplantation

Cite this

Przepiorka, D., Khouri, I., Ippoliti, C., Ueno, N. T., Mehra, R., Körbling, M., Giralt, S., Gajewski, J., Fischer, H., Donato, M., Cleary, K., Claxton, D., Chan, K. W., Braunschweig, I., Van Besien, K., Andersson, B. S., Anderlini, P., & Champlin, R. (1999). Tacrolimus and minidose methotrexate for prevention of acute graft-versus-host disease after HLA-mismatched marrow or blood stem cell transplantation. Bone Marrow Transplantation, 24(7), 763-768. https://doi.org/10.1038/sj.bmt.1701983