Comparative Analysis of Calcineurin Inhibitor-Based Methotrexate and Mycophenolate Mofetil-Containing Regimens for Prevention of Graft-versus-Host Disease after Reduced-Intensity Conditioning Allogeneic Transplantation

Saurabh Chhabra, Ying Liu, Michael T. Hemmer, Luciano Costa, Joseph A. Pidala, Daniel R. Courie, Amin M. Alousi, Navneet S. Majhai, Robert K. Stuart, Dennis Kim, Olle Ringden, Alvaro Urbano-Ispizua, Ayman Saad, Bipin N. Savani, Brenda Cooper, David I. Marks, Gerard Socie, Harry C. Schouten, Helene Schoemans, Hisham Abdel-AzimJean Yared, Jean-Yves Cahn, John Wagner, Joseph H. Antin, Leo F. Verdonck, Leslie Lehmann, Mahmoud D. Aljurf, Margaret L. MacMillan, Mark R. Litzow, Melhem M. Solh, Muna Qayed, Peiman Hematti, Rammurti T. Kamble, Ravi Vij, Roberti Hayashi, Robert P. Gale, Rodrigo Martino, Sachiko Seo, Shahrukh K. Hashmi, Taiga Nishihori, Takanori Teshima, Usama Gergis, Yoshihiro Inamoto, Stephen R. Spellman, Mukta Arora*, Betty K. Hamilton

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


The combination of a calcineurin inhibitor (CNI) such as tacrolimus (TAC) or cyclosporine (CYSP) with methotrexate (MTX) or with mycophenolate mofetil (MMF) has been commonly used for graft-versus-host disease (GVHD) prophylaxis after reduced-intensity conditioning (RIC) allogeneic hematopoietic cell transplantation (alloHCT), but there are limited data comparing efficacy of the 2 regimens. We evaluated 1564 adult patients who underwent RIC alloHCT for acute myelogenous leukemia (AML) and acute lymphoblastic leukemia (ALL), chronic myelogenous leukemia (CML), and myelodysplastic syndrome (MDS) from 2000 to 2013 using HLA-identical sibling (matched related donor [MRD]) or unrelated donor (URD) peripheral blood graft and received CYSP or TAC with MTX or MMF for GVHD prophylaxis. Primary outcomes of the study were acute and chronic GVHD and overall survival (OS). The study divided the patient population into 4 cohorts based on regimen: MMF-TAC, MMF-CYSP, MTX-TAC, and MTX-CYSP. In the URD group, MMF-CYSP was associated with increased risk of grade II to IV acute GVHD (relative risk [RR], 1.78; P <.001) and grade Ill to IV acute GVHD (RR, 1.93; P = .006) compared with MTX-TAC. In the URD group, use of MMF-TAC (versus MTX-TAC) lead to higher nonrelapse mortality. (hazard ratio, 1.48; P = .008). In either group, no there was no difference in chronic GVHD, disease-free survival, and OS among the GVHD prophylaxis regimens. For RIC alloHCT using MRD, there are no differences in outcomes based on GVHD prophylaxis. However, with URD RIC alloHCT, MMF-CYSP was inferior to MTX-based regimens for acute GVHD prevention, but all the regimens were equivalent in terms of chronic GVHD and OS. Prospective studies, targeting URD recipients are needed to confirm these results. (C) 2018 American Society for Blood and Marrow Transplantation.

Original languageEnglish
Pages (from-to)73-85
Number of pages13
JournalBiology of Blood and Marrow Transplantation
Issue number1
Publication statusPublished - Jan 2019


  • Calcineurin inhibitor Tacrolimus
  • Cyclosporine
  • Methotrexate
  • Mycophenolate mofetil
  • Graft-versus-host disease prophylaxis
  • Reduced-intensity conditioning
  • Allogeneic hematopoietic cell transplantation

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