Tacrolimus versus Cyclosporine after Hematopoietic Cell Transplantation for Acquired Aplastic Anemia.


Journal Article

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.

Full Text

Duke Authors

Cited Authors

  • 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

Published Date

  • October 2015

Published In

Volume / Issue

  • 21 / 10

Start / End Page

  • 1776 - 1782

PubMed ID

  • 26033280

Pubmed Central ID

  • 26033280

Electronic International Standard Serial Number (EISSN)

  • 1523-6536

Digital Object Identifier (DOI)

  • 10.1016/j.bbmt.2015.05.023


  • eng

Conference Location

  • United States