Tacrolimus instead of cyclosporine used for prophylaxis against graft-versus-host disease improves outcome after hematopoietic stem cell transplantation from unrelated donors, but not from HLA-identical sibling donors: a nationwide survey conducted in Japan

摘要: Despite recent advances, graft-versus-host disease (GVHD) remains the main cause of treatment failure for patients undergoing allogeneic hematopoietic stem cell transplantation (HSCT). Tacrolimus (FK506) has been increasingly used in place cyclosporine (CSP), and several studies have shown that FK506 reduces incidence acute GVHD more effectively than does CSP. However, no survival benefits demonstrated, established consensus exists on choice these immunosuppressive agents. To compare a CSP-based an FK506-based regimen, we performed large-scale retrospective study by using data 1935 who underwent HSCT from HLA-identical sibling donors (SIB-HSCT) 777 unrelated (UD-HSCT). For UD-HSCT, significantly reduced risk treatment-related mortality (TRM) without increase relapse, thus improving overall (OS) (hazard ratio (HR): 2.20, 95% confidence interval (CI): 1.60-3.04, P<0.0001 grade II-IV GVHD; HR: 1.81, CI: 1.32-2.48, P=0.0003 TRM; 1.62, 1.23-2.14, P=0.0007 OS). This superiority was not observed SIB-HSCT cases. These findings indicate use instead CSP prophylaxis is beneficial UD-HSCT.