Feasibility of tacrolimus, methotrexate, and prednisolone as a graft-versus-host disease prophylaxis in non-T-cell-depleted haploidentical hematopoietic stem cell transplantation for children

Clin Transplant. 2011 Nov-Dec;25(6):892-7. doi: 10.1111/j.1399-0012.2010.01352.x. Epub 2010 Nov 11.

Abstract

In this study, we evaluated the feasibility of our graft-versus-host disease (GVHD) prophylaxis with tacrolimus, methotrexate, and prednisolone in non-T-cell-depleted haploidentical hematopoietic stem cell transplantation (HSCT) for children. Twenty-one consecutive patients including those with hematological malignancies (n = 11), solid tumors (n = 7), and non-malignancies (n = 3) were analyzed. Myeloablative and reduced intensity conditionings were carried out in 5 and 16 patients, respectively, and both of the regimens contained anti-human T-lymphocyte immunoglobulin. Twenty (95%) of the 21 patients achieved primary engraftment. Acute GVHD of grades II-IV and III-IV were observed in nine (47%) and one (5%) patient, respectively, all of which were controllable by steroids. Chronic GVHD was observed in eight (51%) of the 17 evaluable patients, and one of them developed steroid refractory chronic GVHD. Treatment-related mortality occurred in three patients (15%), as a result of acute pancreatitis, chronic GVHD, and EB virus associated lymphoproliferative disease. The median follow-up of the 13 survivors was 24 months, and the two-yr probability of overall survival was 68%. The Karnofsky performance scale score of the 13 survivors was 100%. These results indicated the feasibility of our GVHD prophylaxis in non-T-cell-depleted haploidentical HSCT for children.

MeSH terms

  • Adolescent
  • Adult
  • Anti-Inflammatory Agents / therapeutic use
  • Child
  • Child, Preschool
  • Feasibility Studies
  • Female
  • Follow-Up Studies
  • Graft vs Host Disease / epidemiology
  • Graft vs Host Disease / etiology
  • Graft vs Host Disease / prevention & control*
  • Hematologic Neoplasms / immunology
  • Hematologic Neoplasms / therapy*
  • Hematopoietic Stem Cell Transplantation / adverse effects*
  • Histocompatibility
  • Humans
  • Immunosuppressive Agents / therapeutic use
  • Incidence
  • Infant
  • Infant, Newborn
  • Japan / epidemiology
  • Male
  • Methotrexate / therapeutic use*
  • Prednisolone / therapeutic use*
  • Prognosis
  • Survival Rate
  • T-Lymphocytes / immunology*
  • Tacrolimus / therapeutic use*
  • Transplantation, Homologous
  • Young Adult

Substances

  • Anti-Inflammatory Agents
  • Immunosuppressive Agents
  • Prednisolone
  • Tacrolimus
  • Methotrexate