Tacrolimus versus Cyclosporine after Hematopoietic Cell Transplantation for Acquired Aplastic Anemia.
(Journal Article;Multicenter Study)
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.
Inamoto, Y; Flowers, MED; Wang, T; Urbano-Ispizua, A; Hemmer, MT; Cutler, CS; Couriel, DR; Alousi, AM; Antin, JH; Gale, RP; Gupta, V; Hamilton, BK; Kharfan-Dabaja, MA; Marks, DI; Ringdén, OTH; Socié, G; Solh, MM; Akpek, G; Cairo, MS; Chao, NJ; Hayashi, RJ; Nishihori, T; Reshef, R; Saad, A; Shah, A; Teshima, T; Tallman, MS; Wirk, B; Spellman, SR; Arora, M; Martin, PJ
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