NYMC Faculty Publications

Tacrolimus Versus Cyclosporine After Hematopoietic Cell Transplantation for Acquired Aplastic Anemia

Author Type(s)

Faculty

DOI

10.1016/j.bbmt.2015.05.023

Journal Title

Biology of Blood and Marrow Transplantation

First Page

1776

Last Page

1782

Document Type

Article

Publication Date

10-1-2015

Keywords

Age Factors, Anemia, Aplastic, Cyclosporine, Drug Therapy, Combination, Female, Graft Survival, Graft vs Host Disease, Hematopoietic Stem Cell Transplantation, Humans, Immunosuppressive Agents, Living Donors, Male, Methotrexate, Proportional Hazards Models, Retrospective Studies, Tacrolimus, Transplantation Conditioning, Treatment Outcome

Disciplines

Medicine and Health Sciences

Abstract

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.

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