TY - JOUR
T1 - Efficacy of mycophenolate mofetil in the treatment of chronic graft-versus-host disease
AU - Lopez, Francisco
AU - Parker, Pablo
AU - Nademanee, Auayporn
AU - Rodriguez, Roberto
AU - Al-Kadhimi, Zaid
AU - Bhatia, Ravi
AU - Cohen, Sandra
AU - Falk, Peter
AU - Fung, Henry
AU - Kirschbaum, Mark
AU - Krishnan, Amrita
AU - Kogut, Neil
AU - Molina, Arturo
AU - Nakamura, Ryotaro
AU - O'Donnell, Margaret
AU - Popplewell, Leslie
AU - Pullarkat, Vinod
AU - Rosenthal, Joseph
AU - Sahebi, Firoozeh
AU - Smith, Eileen
AU - Snyder, David
AU - Somlo, George
AU - Spielberger, Ricardo
AU - Stein, Anthony
AU - Sweetman, Robert
AU - Zain, Jasmine
AU - Forman, Stephen
N1 - Funding Information:
Supported in part by United States Public Health Service grant nos. CA30206 and CA33572.
PY - 2005/4
Y1 - 2005/4
N2 - Current treatment of chronic graft-versus-host disease (cGVHD) with prednisone (PSE) alone or with added cyclosporine or tacrolimus still has a very high failure and complication rate, and new treatment approaches are needed for both primary and salvage therapy. Mycophenolate mofetil (MMF) is an immunosuppressive agent currently in use for acute graft-versus-host disease prophylaxis. To determine whether MMF had activity in the treatment of cGVHD, we added MMF to standard cyclosporine, tacrolimus, and/or PSE as salvage/second-line (n = 24) or first-line (n = 10) therapy in 34 patients. Nine (90%) of 10 patients receiving first-line and 18 (75%) of 24 receiving second-line MMF therapy responded. Twelve (35%) patients had a complete remission, 15 (44%) had a partial remission, 5 (15%) had stable disease, and only 2 (6%) had progressive disease. Out of 30 patients receiving PSE, 22 (73%) were able to decrease PSE doses (median decrease of 50%; range, 25%-100%). With a median follow-up of 24 months (range, 6-28 months), 29 (85%) patients are alive. Three patients had to discontinue MMF because of abdominal cramps within 3 months of starting treatment. These data suggest that MMF is an active, well-tolerated agent in the treatment of cGVHD and may have a beneficial effect on the survival of patients with this complication.
AB - Current treatment of chronic graft-versus-host disease (cGVHD) with prednisone (PSE) alone or with added cyclosporine or tacrolimus still has a very high failure and complication rate, and new treatment approaches are needed for both primary and salvage therapy. Mycophenolate mofetil (MMF) is an immunosuppressive agent currently in use for acute graft-versus-host disease prophylaxis. To determine whether MMF had activity in the treatment of cGVHD, we added MMF to standard cyclosporine, tacrolimus, and/or PSE as salvage/second-line (n = 24) or first-line (n = 10) therapy in 34 patients. Nine (90%) of 10 patients receiving first-line and 18 (75%) of 24 receiving second-line MMF therapy responded. Twelve (35%) patients had a complete remission, 15 (44%) had a partial remission, 5 (15%) had stable disease, and only 2 (6%) had progressive disease. Out of 30 patients receiving PSE, 22 (73%) were able to decrease PSE doses (median decrease of 50%; range, 25%-100%). With a median follow-up of 24 months (range, 6-28 months), 29 (85%) patients are alive. Three patients had to discontinue MMF because of abdominal cramps within 3 months of starting treatment. These data suggest that MMF is an active, well-tolerated agent in the treatment of cGVHD and may have a beneficial effect on the survival of patients with this complication.
KW - Chronic graft-versus-host disease
KW - Mycophenolate mofetil
KW - Transplantations
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U2 - 10.1016/j.bbmt.2005.01.011
DO - 10.1016/j.bbmt.2005.01.011
M3 - Article
C2 - 15812396
AN - SCOPUS:20144388150
SN - 1083-8791
VL - 11
SP - 307
EP - 313
JO - Biology of Blood and Marrow Transplantation
JF - Biology of Blood and Marrow Transplantation
IS - 4
ER -