Synapse - Impact of omitting post-transplant minidose-methotrexate doses in allogeneic hematopoietic cell transplantation

Impact of omitting post-transplant minidose-methotrexate doses in allogeneic hematopoietic cell transplantation Journal Article

Authors:	Lin, A.; Brown, S.; Maloy, M.; Ruiz, J. D.; Devlin, S.; DeRespiris, L.; Proli, A.; Jakubowski, A. A.; Papadopoulos, E. B.; Sauter, C. S.; Tamari, R.; Castro-Malaspina, H.; Shaffer, B.; Barker, J.; Perales, M. A.; Giralt, S. A.; Gyurkocza, B.
Article Title:	Impact of omitting post-transplant minidose-methotrexate doses in allogeneic hematopoietic cell transplantation
Abstract:	Given prophylactic methotrexate (MTX) is often held in the setting of toxicity we investigated the impact of omitting minidose-MTX dose(s). Outcomes were compared between patients who had 1–3 doses omitted and those who received all four planned doses of minidose-MTX. Of 370 consecutive patients, 50 had MTX dose(s) omitted. When MTX was omitted, initial management was mycophenolate mofetil (MMF; 36/50 patients) with or without corticosteroids (14/50 patients). Rates of grade 3–4 acute GVHD were similar between groups. Omission of minidose-MTX resulted in an increased risk of chronic GVHD (cGVHD; HR 2.27; p =.024) and decreased overall survival (HR 1.61; p =.024). However, other transplant-related outcomes were comparable. In summary, omission of minidose-MTX doses was not associated with an increased risk of acute GVHD when an alternative was added (e.g. MMF ± corticosteroids). This did not abrogate the increased risk of cGVHD or decreased overall survival. © 2022 Informa UK Limited, trading as Taylor & Francis Group.
Keywords:	adult; aged; major clinical study; overall survival; methotrexate; outcome assessment; mucosa inflammation; hematopoietic stem cell transplantation; continuous infusion; acute kidney failure; acute graft versus host disease; chronic graft versus host disease; myeloablative conditioning; nonmyeloablative conditioning; graft versus host reaction; reduced intensity conditioning; transplantation conditioning; allogeneic hematopoietic stem cell transplantation; pleura effusion; hyperbilirubinemia; corticosteroid; calcineurin inhibitor; tacrolimus; graft vs host disease; cyclosporine; immunosuppressive agents; immunosuppressive agent; adverse event; graft-versus-host disease; adrenal cortex hormones; procedures; mycophenolic acid; anasarca; mycophenolate mofetil; humans; human; male; female; article
Journal Title:	Leukemia and Lymphoma
Volume:	63
Issue:	7
ISSN:	1042-8194
Publisher:	Taylor & Francis Group
Date Published:	2022-01-01
Start Page:	1686
End Page:	1693
Language:	English
DOI:	10.1080/10428194.2022.2032036
PUBMED:	35142567
PROVIDER:	scopus
PMCID:	PMC9983694
DOI/URL:	https://www.scopus.com/inward/record.uri?eid=2-s2.0-85125136846&doi=10.1080%2f10428194.2022.2032036&partnerID=40&md5=a3c68bc635f9d69f6cb526875e6e5b32
Notes:	Article -- Export Date: 1 August 2022 -- Source: Scopus