Cyclosporine Plus Methotrexate or Cyclosporine Plu

Authors: Alok Gupta Sachin Punatar Libin Mathew Sadhana Kannan Navin Khattry

Publish Date: 2015/08/06

Volume: 32, Issue: 3, Pages: 248-256

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Abstract

We sought to compare two graftversushost disease GVHD prophylaxis regimen cyclosporine and methotrexate CsA+MTX with CsA+mycophenolate mofetil MMF in 77 acute leukemia patients who underwent hematopoietic stem cell transplant HSCT between January 2008 and March 2013 Fiftythree patients received CsA+MTX while 24 received CsA+MMF The incidence of grade 3–4 mucositis and grade 3–4 diarrhea was 74 and 6  with CsA+MTX compared to 33  and 21  with CsA+MMF P = 0001 and 009 respectively Fortytwo 79  patients in CsA+MTX group required total parenteral nutrition compared to 14 58  in CsA+MMF group P = 009 The incidence of engraftment fever was 17  with CsA+MTX and 41  with CsA+MMF P = 002 The median time to neutrophil and platelet engraftment was 14 days and 13 days with CsA+MTX compared to 12 days and 10 days with CsA+MMF P = 0003 and 008 respectively The incidence of any grade and grade II–IV acute GVHD was 45 and 13  with CsA+MTX compared to 42 and 29  with CsA+MMF P = NS Incidence of overall and extensive chronic GVHD was 57 and 38  with CsA+MTX compared to 42 and 17  with CsA+MMF P = NS Incidence of relapse was 38  with CsA+MTX compared to 33  with CsA+MMF P = NS TRM was 6  with CsA+MTX and 21  with CsA+MMF P = NS At 2 years overall survival OS was 64  in CsA+MTX group compared to 46  in CsA+MMF group P = NS We conclude that CsA+MMF is associated with lesser toxicity faster myeloid engraftment and similar rates of acute and chronic GVHD TRM relapse and OS compared to CsA+MTX in acute leukemia transplant

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