Impact of Cyclosporine Levels on the Development of Acute Graft versus Host Disease after Reduced Intensity Conditioning Allogeneic Stem Cell Transplantation

We analyze the impact of cyclosporine (CsA) levels in the development of acute graft-versus-host disease (aGVHD) after reduced intensity conditioning allogeneic hematopoietic transplantation (allo-RIC). We retrospectively evaluated 156 consecutive patients who underwent HLA-identical sibling allo-RIC at our institution. CsA median blood levels in the 1st, 2nd, 3rd and 4th weeks after allo-RIC were 134 (range: 10–444), 219 (54–656), 253 (53–910) and 224 (30–699) ng/mL; 60%, 16%, 11% and 17% of the patients had median CsA blood levels below 150 ng/mL during these weeks. 53 patients developed grade 2–4 aGVHD for a cumulative incidence of 45% (95% CI 34–50%) at a median of 42 days. Low CsA levels on the 3rd week and sex-mismatch were associated with the development of GVHD. Risk factors for 1-year NRM and OS were advanced disease status (HR: 2.2,P=0.02) and development of grade 2–4 aGVHD (HR: 2.5,P<0.01), while there was a trend for higher NRM in patients with a low median CsA concentration on the 3rd week (P=0.06). These results emphasize the relevance of sustaining adequate levels of blood CsA by close monitoring and dose adjustments, particularly when engraftment becomes evident. CsA adequate management will impact on long-term outcomes in the allo-RIC setting.

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Decreased Risk of Acute Graft-versus-Host Disease Using Reduced Intensity Conditioning Compared to Myeloablative Conditioning is Independent of Donor-Recipient T-cell Chimerism

Journal of Transplantation Technologies & Research ◽

10.4172/2161-0991.1000142 ◽

2014 ◽

Vol 04 (02) ◽

Cited By ~ 1

Author(s):

Behnam Sadeghi

Keyword(s):

T Cell ◽

Graft Versus Host Disease ◽

Reduced Intensity Conditioning ◽

Myeloablative Conditioning ◽

Host Disease ◽

Graft Versus Host ◽

Reduced Intensity ◽

Acute Graft

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The impact of histopathologic examination of graft-versus-host disease in the era of reduced-intensity conditioning regimen: a study from the Gruppo Italiano Trapianto di Midollo Osseo

Human Pathology ◽

10.1016/j.humpath.2010.07.004 ◽

2011 ◽

Vol 42 (2) ◽

pp. 254-268 ◽

Cited By ~ 6

Author(s):

Daniela Massi ◽

Cristina Fondi ◽

Chiara Nozzoli ◽

Silvia Benemei ◽

Francesco Lapi ◽

...

Keyword(s):

Graft Versus Host Disease ◽

Conditioning Regimen ◽

Histopathologic Examination ◽

Reduced Intensity Conditioning ◽

Host Disease ◽

Graft Versus Host ◽

Reduced Intensity Conditioning Regimen ◽

The Impact ◽

Midollo Osseo ◽

Reduced Intensity

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Predicting death in patients with acute graft-versus-host disease after reduced-intensity conditioning

The Lancet Haematology ◽

10.1016/s2352-3026(17)30142-4 ◽

2017 ◽

Vol 4 (9) ◽

pp. e400-e401

Author(s):

Eva M Weissinger ◽

Arnold Ganser

Keyword(s):

Graft Versus Host Disease ◽

Reduced Intensity Conditioning ◽

Host Disease ◽

Graft Versus Host ◽

Reduced Intensity ◽

Acute Graft

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Effect of Early Post-Transplantation Tacrolimus Concentration on the Risk of Acute Graft-Versus-Host Disease in Allogenic Stem Cell Transplantation

Cancers ◽

10.3390/cancers13040613 ◽

2021 ◽

Vol 13 (4) ◽

pp. 613

Author(s):

Nidhi Sharma ◽

Qiuhong Zhao ◽

Bin Ni ◽

Patrick Elder ◽

Marcin Puto ◽

...

Keyword(s):

Stem Cell ◽

Graft Versus Host Disease ◽

Tacrolimus Concentration ◽

Cell Transplant ◽

Hematopoietic Stem ◽

Host Disease ◽

Graft Versus Host ◽

The Impact ◽

Risk Of Relapse ◽

Acute Graft

Acute graft versus host disease (aGVHD) remains a leading cause of morbidity and mortality in allogeneic hematopoietic stem cell transplant (allo-HSCT). Tacrolimus (TAC), a calcineurin inhibitor that prevents T-cell activation, is commonly used as a GVHD prophylaxis. However, there is variability in the serum concentrations of TAC, and little is known on the impact of early TAC levels on aGVHD. We retrospectively analyzed 673 consecutive patients undergoing allo-HSCT at the Ohio State University between 2002 and 2016. Week 1 TAC was associated with a lower risk of aGVHD II–IV at TAC level ≥10.15 ng/mL (p = 0.03) compared to the lowest quartile. The cumulative incidence of relapse at 1, 3 and 5 years was 33%, 38% and 41%, respectively. TAC levels at week 2, ≥11.55 ng/mL, were associated with an increased risk of relapse (p = 0.01) compared to the lowest quartile. Subset analysis with acute myeloid leukemia and myelodysplastic syndrome patients showed significantly reduced aGVHD with TAC level ≥10.15 ng/mL at week 1 and a higher risk of relapse associated with week 2 TAC level ≥11.55 ng/mL (p = 0.02). Hence, achieving ≥10 ng/mL during the first week of HCT may mitigate the risk of aGVHD. However, levels (>11 ng/mL) beyond the first week may be associated with suppressed graft versus tumor effect and higher relapse.

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