Prognostic impact of the dosage of methotrexate combined with tacrolimus for graft-versus-host disease prophylaxis after cord blood transplantation
The optimal dosage of methotrexate (MTX) for graft-versus-host disease (GVHD) prophylaxis after cord blood transplantation (CBT) has not been well elucidated. Therefore, we conducted a retrospective study comparing a mini-MTX group (5 mg/m 2 on day 1, 3 and 6) to a short-MTX group (10 mg/m 2 on day...
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| Veröffentlicht in: | International journal of hematology 2021-08, Vol.114 (2), p.252-262 |
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| creator | Adachi, Miwa Yokota, Daisuke Hirata, Hiroya Koyauchi, Katsumi Dohtan, Satoshi Oka, Shinichiro Sakamoto, Nami Takaba, Masamitsu Takemura, Tomonari Nagata, Yasuyuki Naito, Kensuke Ono, Takaaki |
| description | The optimal dosage of methotrexate (MTX) for graft-versus-host disease (GVHD) prophylaxis after cord blood transplantation (CBT) has not been well elucidated. Therefore, we conducted a retrospective study comparing a mini-MTX group (5 mg/m
2
on day 1, 3 and 6) to a short-MTX group (10 mg/m
2
on day 1 and 7 mg/m
2
on day 3 and 6) after CBT. Sixty-three patients were classified as the mini-MTX group and 20 as the short-MTX group. The median time and cumulative incidence of neutrophil engraftment did not vary between the two groups. The cumulative incidence of grade 2–4 and grade 3–4 acute GVHD was similar in both groups. Overall survival in the mini-MTX group was significantly lower than in the short-MTX group (46.9% vs. 88.7% at 1 year,
p
|
| doi_str_mv | 10.1007/s12185-021-03161-3 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2537637225</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2554132659</sourcerecordid><originalsourceid>FETCH-LOGICAL-c460t-1cffe07ac66aba7bab4f76880c4453e7a338ba550ff72a60bcdd346f2f6702bf3</originalsourceid><addsrcrecordid>eNp9kc2KFTEUhIMoeL36Aq4CbtxE89NJepYy-AcD40LX4XQ6uZ2hu9PmpHXmOXxhM15BcDGr4sBXRXGKkJeCvxGc27copOg141IwroQRTD0iB9EbzZS13WNy4BdSM20Ff0qeId5wLizv7IH8-lLyac1Yk6dp2cBXmiOtU6BjRjiF-2sJdcq1hFuogfq8DGkNI_2Z6kQr-JLntOxIYy70VCBW9iMU3JFNLZWOCQNgoFvJ23Q3w21C2phQWlAZ6TDnPNJaYMVthrVCTXl9Tp5EmDG8-KtH8u3D-6-Xn9jV9cfPl--umO8Mr0z4GAO34I2BAewAQxet6Xvuu06rYEGpfgCteYxWguGDH0fVmSijsVwOUR3J63NuK_d9D1jdktCHuRUJeUcntbJGWdn0SF79h97kvaytXaN0J5Q0-qJR8ky1pyCWEN1W0gLlzgnu7ndy551c28n92cmpZlJnEzZ4PYXyL_oB12-7eZob</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2554132659</pqid></control><display><type>article</type><title>Prognostic impact of the dosage of methotrexate combined with tacrolimus for graft-versus-host disease prophylaxis after cord blood transplantation</title><source>SpringerLink Journals</source><creator>Adachi, Miwa ; Yokota, Daisuke ; Hirata, Hiroya ; Koyauchi, Katsumi ; Dohtan, Satoshi ; Oka, Shinichiro ; Sakamoto, Nami ; Takaba, Masamitsu ; Takemura, Tomonari ; Nagata, Yasuyuki ; Naito, Kensuke ; Ono, Takaaki</creator><creatorcontrib>Adachi, Miwa ; Yokota, Daisuke ; Hirata, Hiroya ; Koyauchi, Katsumi ; Dohtan, Satoshi ; Oka, Shinichiro ; Sakamoto, Nami ; Takaba, Masamitsu ; Takemura, Tomonari ; Nagata, Yasuyuki ; Naito, Kensuke ; Ono, Takaaki</creatorcontrib><description>The optimal dosage of methotrexate (MTX) for graft-versus-host disease (GVHD) prophylaxis after cord blood transplantation (CBT) has not been well elucidated. Therefore, we conducted a retrospective study comparing a mini-MTX group (5 mg/m
2
on day 1, 3 and 6) to a short-MTX group (10 mg/m
2
on day 1 and 7 mg/m
2
on day 3 and 6) after CBT. Sixty-three patients were classified as the mini-MTX group and 20 as the short-MTX group. The median time and cumulative incidence of neutrophil engraftment did not vary between the two groups. The cumulative incidence of grade 2–4 and grade 3–4 acute GVHD was similar in both groups. Overall survival in the mini-MTX group was significantly lower than in the short-MTX group (46.9% vs. 88.7% at 1 year,
p
< 0.01), contributing to higher non-relapse mortality (NRM) in the mini-MTX group (32.0% vs. 5.0% at 1 year,
p
= 0.02). In multivariate analysis, the mini-MTX regimen was the most powerful prognostic factor for OS (hazard ratio 4.11;
p
= 0.03). Although the reduced dosage of MTX had no effect on neutrophil engraftment, increased NRM due to higher incidence of infection, graft failure, and severe acute GVHD resulted in a lower survival rate in the mini-MTX group after CBT.</description><identifier>ISSN: 0925-5710</identifier><identifier>EISSN: 1865-3774</identifier><identifier>DOI: 10.1007/s12185-021-03161-3</identifier><language>eng</language><publisher>Singapore: Springer Singapore</publisher><subject>Blood ; Cord blood ; Disease prevention ; Dosage ; Graft rejection ; Graft versus host disease ; Graft-versus-host reaction ; Grafting ; Grafts ; Hematology ; Leukocytes (neutrophilic) ; Medicine ; Medicine & Public Health ; Methotrexate ; Multivariate analysis ; Neutrophils ; Oncology ; Original Article ; Prophylaxis ; Survival ; Tacrolimus ; Transplantation</subject><ispartof>International journal of hematology, 2021-08, Vol.114 (2), p.252-262</ispartof><rights>Japanese Society of Hematology 2021</rights><rights>Japanese Society of Hematology 2021.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c460t-1cffe07ac66aba7bab4f76880c4453e7a338ba550ff72a60bcdd346f2f6702bf3</citedby><cites>FETCH-LOGICAL-c460t-1cffe07ac66aba7bab4f76880c4453e7a338ba550ff72a60bcdd346f2f6702bf3</cites><orcidid>0000-0002-9290-8678</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s12185-021-03161-3$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s12185-021-03161-3$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,780,784,27924,27925,41488,42557,51319</link.rule.ids></links><search><creatorcontrib>Adachi, Miwa</creatorcontrib><creatorcontrib>Yokota, Daisuke</creatorcontrib><creatorcontrib>Hirata, Hiroya</creatorcontrib><creatorcontrib>Koyauchi, Katsumi</creatorcontrib><creatorcontrib>Dohtan, Satoshi</creatorcontrib><creatorcontrib>Oka, Shinichiro</creatorcontrib><creatorcontrib>Sakamoto, Nami</creatorcontrib><creatorcontrib>Takaba, Masamitsu</creatorcontrib><creatorcontrib>Takemura, Tomonari</creatorcontrib><creatorcontrib>Nagata, Yasuyuki</creatorcontrib><creatorcontrib>Naito, Kensuke</creatorcontrib><creatorcontrib>Ono, Takaaki</creatorcontrib><title>Prognostic impact of the dosage of methotrexate combined with tacrolimus for graft-versus-host disease prophylaxis after cord blood transplantation</title><title>International journal of hematology</title><addtitle>Int J Hematol</addtitle><description>The optimal dosage of methotrexate (MTX) for graft-versus-host disease (GVHD) prophylaxis after cord blood transplantation (CBT) has not been well elucidated. Therefore, we conducted a retrospective study comparing a mini-MTX group (5 mg/m
2
on day 1, 3 and 6) to a short-MTX group (10 mg/m
2
on day 1 and 7 mg/m
2
on day 3 and 6) after CBT. Sixty-three patients were classified as the mini-MTX group and 20 as the short-MTX group. The median time and cumulative incidence of neutrophil engraftment did not vary between the two groups. The cumulative incidence of grade 2–4 and grade 3–4 acute GVHD was similar in both groups. Overall survival in the mini-MTX group was significantly lower than in the short-MTX group (46.9% vs. 88.7% at 1 year,
p
< 0.01), contributing to higher non-relapse mortality (NRM) in the mini-MTX group (32.0% vs. 5.0% at 1 year,
p
= 0.02). In multivariate analysis, the mini-MTX regimen was the most powerful prognostic factor for OS (hazard ratio 4.11;
p
= 0.03). Although the reduced dosage of MTX had no effect on neutrophil engraftment, increased NRM due to higher incidence of infection, graft failure, and severe acute GVHD resulted in a lower survival rate in the mini-MTX group after CBT.</description><subject>Blood</subject><subject>Cord blood</subject><subject>Disease prevention</subject><subject>Dosage</subject><subject>Graft rejection</subject><subject>Graft versus host disease</subject><subject>Graft-versus-host reaction</subject><subject>Grafting</subject><subject>Grafts</subject><subject>Hematology</subject><subject>Leukocytes (neutrophilic)</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Methotrexate</subject><subject>Multivariate analysis</subject><subject>Neutrophils</subject><subject>Oncology</subject><subject>Original Article</subject><subject>Prophylaxis</subject><subject>Survival</subject><subject>Tacrolimus</subject><subject>Transplantation</subject><issn>0925-5710</issn><issn>1865-3774</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp9kc2KFTEUhIMoeL36Aq4CbtxE89NJepYy-AcD40LX4XQ6uZ2hu9PmpHXmOXxhM15BcDGr4sBXRXGKkJeCvxGc27copOg141IwroQRTD0iB9EbzZS13WNy4BdSM20Ff0qeId5wLizv7IH8-lLyac1Yk6dp2cBXmiOtU6BjRjiF-2sJdcq1hFuogfq8DGkNI_2Z6kQr-JLntOxIYy70VCBW9iMU3JFNLZWOCQNgoFvJ23Q3w21C2phQWlAZ6TDnPNJaYMVthrVCTXl9Tp5EmDG8-KtH8u3D-6-Xn9jV9cfPl--umO8Mr0z4GAO34I2BAewAQxet6Xvuu06rYEGpfgCteYxWguGDH0fVmSijsVwOUR3J63NuK_d9D1jdktCHuRUJeUcntbJGWdn0SF79h97kvaytXaN0J5Q0-qJR8ky1pyCWEN1W0gLlzgnu7ndy551c28n92cmpZlJnEzZ4PYXyL_oB12-7eZob</recordid><startdate>20210801</startdate><enddate>20210801</enddate><creator>Adachi, Miwa</creator><creator>Yokota, Daisuke</creator><creator>Hirata, Hiroya</creator><creator>Koyauchi, Katsumi</creator><creator>Dohtan, Satoshi</creator><creator>Oka, Shinichiro</creator><creator>Sakamoto, Nami</creator><creator>Takaba, Masamitsu</creator><creator>Takemura, Tomonari</creator><creator>Nagata, Yasuyuki</creator><creator>Naito, Kensuke</creator><creator>Ono, Takaaki</creator><general>Springer Singapore</general><general>Springer Nature B.V</general><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7T5</scope><scope>7T7</scope><scope>7TM</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>C1K</scope><scope>CCPQU</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>H94</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-9290-8678</orcidid></search><sort><creationdate>20210801</creationdate><title>Prognostic impact of the dosage of methotrexate combined with tacrolimus for graft-versus-host disease prophylaxis after cord blood transplantation</title><author>Adachi, Miwa ; Yokota, Daisuke ; Hirata, Hiroya ; Koyauchi, Katsumi ; Dohtan, Satoshi ; Oka, Shinichiro ; Sakamoto, Nami ; Takaba, Masamitsu ; Takemura, Tomonari ; Nagata, Yasuyuki ; Naito, Kensuke ; Ono, Takaaki</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c460t-1cffe07ac66aba7bab4f76880c4453e7a338ba550ff72a60bcdd346f2f6702bf3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Blood</topic><topic>Cord blood</topic><topic>Disease prevention</topic><topic>Dosage</topic><topic>Graft rejection</topic><topic>Graft versus host disease</topic><topic>Graft-versus-host reaction</topic><topic>Grafting</topic><topic>Grafts</topic><topic>Hematology</topic><topic>Leukocytes (neutrophilic)</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Methotrexate</topic><topic>Multivariate analysis</topic><topic>Neutrophils</topic><topic>Oncology</topic><topic>Original Article</topic><topic>Prophylaxis</topic><topic>Survival</topic><topic>Tacrolimus</topic><topic>Transplantation</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Adachi, Miwa</creatorcontrib><creatorcontrib>Yokota, Daisuke</creatorcontrib><creatorcontrib>Hirata, Hiroya</creatorcontrib><creatorcontrib>Koyauchi, Katsumi</creatorcontrib><creatorcontrib>Dohtan, Satoshi</creatorcontrib><creatorcontrib>Oka, Shinichiro</creatorcontrib><creatorcontrib>Sakamoto, Nami</creatorcontrib><creatorcontrib>Takaba, Masamitsu</creatorcontrib><creatorcontrib>Takemura, Tomonari</creatorcontrib><creatorcontrib>Nagata, Yasuyuki</creatorcontrib><creatorcontrib>Naito, Kensuke</creatorcontrib><creatorcontrib>Ono, Takaaki</creatorcontrib><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Immunology Abstracts</collection><collection>Industrial and Applied Microbiology Abstracts (Microbiology A)</collection><collection>Nucleic Acids Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>Environmental Sciences and Pollution Management</collection><collection>ProQuest One Community College</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>International journal of hematology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Adachi, Miwa</au><au>Yokota, Daisuke</au><au>Hirata, Hiroya</au><au>Koyauchi, Katsumi</au><au>Dohtan, Satoshi</au><au>Oka, Shinichiro</au><au>Sakamoto, Nami</au><au>Takaba, Masamitsu</au><au>Takemura, Tomonari</au><au>Nagata, Yasuyuki</au><au>Naito, Kensuke</au><au>Ono, Takaaki</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Prognostic impact of the dosage of methotrexate combined with tacrolimus for graft-versus-host disease prophylaxis after cord blood transplantation</atitle><jtitle>International journal of hematology</jtitle><stitle>Int J Hematol</stitle><date>2021-08-01</date><risdate>2021</risdate><volume>114</volume><issue>2</issue><spage>252</spage><epage>262</epage><pages>252-262</pages><issn>0925-5710</issn><eissn>1865-3774</eissn><abstract>The optimal dosage of methotrexate (MTX) for graft-versus-host disease (GVHD) prophylaxis after cord blood transplantation (CBT) has not been well elucidated. Therefore, we conducted a retrospective study comparing a mini-MTX group (5 mg/m
2
on day 1, 3 and 6) to a short-MTX group (10 mg/m
2
on day 1 and 7 mg/m
2
on day 3 and 6) after CBT. Sixty-three patients were classified as the mini-MTX group and 20 as the short-MTX group. The median time and cumulative incidence of neutrophil engraftment did not vary between the two groups. The cumulative incidence of grade 2–4 and grade 3–4 acute GVHD was similar in both groups. Overall survival in the mini-MTX group was significantly lower than in the short-MTX group (46.9% vs. 88.7% at 1 year,
p
< 0.01), contributing to higher non-relapse mortality (NRM) in the mini-MTX group (32.0% vs. 5.0% at 1 year,
p
= 0.02). In multivariate analysis, the mini-MTX regimen was the most powerful prognostic factor for OS (hazard ratio 4.11;
p
= 0.03). Although the reduced dosage of MTX had no effect on neutrophil engraftment, increased NRM due to higher incidence of infection, graft failure, and severe acute GVHD resulted in a lower survival rate in the mini-MTX group after CBT.</abstract><cop>Singapore</cop><pub>Springer Singapore</pub><doi>10.1007/s12185-021-03161-3</doi><tpages>11</tpages><orcidid>https://orcid.org/0000-0002-9290-8678</orcidid></addata></record> |
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| ispartof | International journal of hematology, 2021-08, Vol.114 (2), p.252-262 |
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| language | eng |
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| subjects | Blood Cord blood Disease prevention Dosage Graft rejection Graft versus host disease Graft-versus-host reaction Grafting Grafts Hematology Leukocytes (neutrophilic) Medicine Medicine & Public Health Methotrexate Multivariate analysis Neutrophils Oncology Original Article Prophylaxis Survival Tacrolimus Transplantation |
| title | Prognostic impact of the dosage of methotrexate combined with tacrolimus for graft-versus-host disease prophylaxis after cord blood transplantation |
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