Tacrolimus/sirolimus vs tacrolimus/methotrexate as GVHD prophylaxis after matched, related donor allogeneic HCT

Corey Cutler, Brent Logan, Ryotaro Nakamura, Laura Johnston, Sung Choi, David Porter, William J. Hogan, Marcelo Pasquini, Margaret L. MacMillan, Jack W. Hsu, Edmund K. Waller, Stephan Grupp, Philip McCarthy, Juan Wu, Zhen Huan Hu, Shelly L. Carter, Mary M. Horowitz, Joseph H. Antin

Research output: Contribution to journalArticle

99 Scopus citations

Abstract

Grades 2-4 acute graft-versus-host disease (GVHD) occurs in approximately 35% of matched, related donor (MRD) allogeneic hematopoietic cell transplantation (HCT) recipients. We sought to determine if the combination of tacrolimus and sirolimus (Tac/Sir) was more effective than tacrolimus and methotrexate (Tac/Mtx) in preventing acute GVHD and early mortality after allogeneic MRD HCT in a phase 3, multicenter trial. The primary end point of the trial was to compare 114-day grades 2-4 acute GVHD-free survival using an intention-to-treat analysis of 304 randomized subjects. There was no difference in the probability of day 114 grades 2-4 acute GVHD-free survival (67% vs 62%, P = .38). Grades 2-4 GVHD was similar in the Tac/Sir and Tac/Mtx arms (26% vs 34%, P = .48). Neutrophil and platelet engraftment were more rapid in the Tac/Sir arm (14 vs 16 days, P < .001; 16 vs 19 days, P = .03). Oropharyngeal mucositis was less severe in the Tac/Sir arm (peak Oral Mucositis Assessment Scale score 0.70 vs 0.96, P < .001), but otherwise toxicity was similar. Chronic GVHD, relapse-free survival, and overall survival at 2 years were no different between study arms (53% vs 45%, P = .06; 53% vs 54%, P = .77; and 59% vs 63%, P = .36). Based on similar long-term outcomes, more rapid engraftment, and less oropharyngeal mucositis, the combination of Tac/Sir is an acceptable alternative to Tac/Mtx after MRDHCT.

Original languageEnglish (US)
Pages (from-to)1372-1377
Number of pages6
JournalBlood
Volume124
Issue number8
DOIs
StatePublished - Aug 21 2014

ASJC Scopus subject areas

  • Biochemistry
  • Immunology
  • Hematology
  • Cell Biology

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    Cutler, C., Logan, B., Nakamura, R., Johnston, L., Choi, S., Porter, D., Hogan, W. J., Pasquini, M., MacMillan, M. L., Hsu, J. W., Waller, E. K., Grupp, S., McCarthy, P., Wu, J., Hu, Z. H., Carter, S. L., Horowitz, M. M., & Antin, J. H. (2014). Tacrolimus/sirolimus vs tacrolimus/methotrexate as GVHD prophylaxis after matched, related donor allogeneic HCT. Blood, 124(8), 1372-1377. https://doi.org/10.1182/blood-2014-04-567164