scholarly journals Graft-Versus-Host Disease Prophylaxis in Reduced Intensity Conditioning Allogeneic Hematopoietic Cell Transplantation: Comparing the Efficacy of Mycophenolate Mofetil and Methotrexate in Combination with Calcineurin Inhibitor

2018 ◽  
Vol 24 (3) ◽  
pp. S170-S171
Author(s):  
Saurabh Chhabra ◽  
Ying Liu ◽  
Michael Hemmer ◽  
Tao Wang ◽  
Betty K. Hamilton ◽  
...  
Keyword(s):  
Mycophenolate Mofetil ◽  
Cell Transplantation ◽  
Graft Versus Host Disease ◽  
Calcineurin Inhibitor ◽  
Hematopoietic Cell Transplantation ◽  
Hematopoietic Cell ◽  
Allogeneic Hematopoietic Cell Transplantation ◽  
Reduced Intensity Conditioning ◽  
Graft Versus Host ◽  
Reduced Intensity

Reduced-intensity conditioning significantly improves survival of patients with hemophagocytic lymphohistiocytosis undergoing allogeneic hematopoietic cell transplantation

Blood ◽  
2010 ◽  
Vol 116 (26) ◽  
pp. 5824-5831 ◽  
Author(s):  
Rebecca A. Marsh ◽  
Gretchen Vaughn ◽  
Mi-Ok Kim ◽  
Dandan Li ◽  
Sonata Jodele ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Cell Transplantation ◽  
Graft Versus Host Disease ◽  
Hemophagocytic Lymphohistiocytosis ◽  
Hematopoietic Cell Transplantation ◽  
Donor Lymphocyte Infusion ◽  
Hematopoietic Cell ◽  
Reduced Intensity Conditioning ◽  
Graft Versus Host ◽  
Reduced Intensity

Abstract Recent experience suggests that reduced-intensity conditioning (RIC) regimens can improve the outcomes of patients with hemophagocytic lymphohistiocytosis (HLH) undergoing allogeneic hematopoietic cell transplantation (HCT). However, studies directly comparing RIC to myeloablative conditioning (MAC) regimens are lacking. Forty patients with HLH underwent allogeneic HCT between 2003-2009 at Cincinnati Children's Hospital. Fourteen patients received MAC consisting of busulfan, cyclophosphamide, and antithymocyte globulin plus or minus etoposide. Twenty-six patients received RIC consisting of fludarabine, melphalan, and alemtuzumab. All patients engrafted. Acute graft-versus-host disease grades II to III occurred in 14% of MAC patients and 8% of RIC patients (P = .3171). Posttransplantation mixed donor/recipient chimerism developed in 18% of MAC patients and 65% of RIC patients (P = .0110). The majority of patients with mixed chimerism received intervention with reduction of immune suppression plus or minus donor lymphocyte infusion or stem cell boost, which stabilized or increased donor contribution to hematopoiesis and prevented relapse of HLH in all but 1 patient. Grade II to III graft-versus-host disease occurred in 5 of 14 RIC patients after donor lymphocyte infusion. The overall estimated 3-year survival after HCT was 43% (confidence interval = ± 26%) for MAC patients and 92% (confidence interval = ± 11%) for RIC patients (P = .0001). We conclude that RIC significantly improves the outcome of patients with HLH undergoing allogeneic HCT.

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