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<p>Rapid tapering of cyclosporine (CsA) in the early phase after allogeneic transplantation may induce a potent graft-versus-leukemia/lymphoma (GVL) effect. We retrospectively reviewed the outcomes of patients with high-risk hematological malignancies who underwent their first transplantation at our institution. The blood CsA concentration was maintained at&#xa0;around 300&#xa0;ng/ml. Our planned schedule for tapering CsA in patients without graft-versus-host disease (GVHD) or with limited GVHD was to reduce the dose by 10% per week starting from day 30 for related HSCT or from day 50 for unrelated HSCT. In total, we began tapering CsA in 36, and classified them into 2 an “On-schedule group” or “Delayed group” based on the timing of starting tapering. The cumulative incidences of grade II-IV acute GVHD overall&#xa0;were 33.8% and 39.4% (<i>P</i> = 0.746)&#xa0;in the On-schedule and Delayed groups. The On-schedule group showed no significant difference in non-relapse mortality, but showed a trend toward a higher relapse rate, resulting in significantly worse overall survival (55.6% vs 72.2% at 1y,&#xa0;<i>P</i> = 0.025) and worse disease-free survival&#xa0;(38.9% vs 66.7% at 1y,&#xa0;<i>P</i> = 0.059). These findings suggest that early CsA tapering after HSCT in high-risk patients was not effective.</p>

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Rapid tapering of cyclosporine after allogeneic transplantation for high-risk hematological malignancies

  • 期刊论文

  • 发表日期：

    2025年2月6日

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  • Ayumi Gomyo,
  • Shinichi Kako,
  • Masakatsu Kawamura,
  • Shunto Kawamura,
  • Junko Takeshita,
  • Nozomu Yoshino,
  • Yukiko Misaki,
  • Kazuki Yoshimura,
  • Shinpei Matsumi,
  • Yu Akahoshi,
  • Masaharu Tamaki,
  • Machiko Kusuda,
  • Kazuaki Kameda,
  • Hidenori Wada,
  • Koji Kawamura,
  • Miki Sato,
  • Kiriko Terasako-Saito,
  • Shun-ichi Kimura,
  • Hideki Nakasone,
  • Yoshinobu Kanda

摘要

Rapid tapering of cyclosporine (CsA) in the early phase after allogeneic transplantation may induce a potent graft-versus-leukemia/lymphoma (GVL) effect. We retrospectively reviewed the outcomes of patients with high-risk hematological malignancies who underwent their first transplantation at our institution. The blood CsA concentration was maintained at around 300 ng/ml. Our planned schedule for tapering CsA in patients without graft-versus-host disease (GVHD) or with limited GVHD was to reduce the dose by 10% per week starting from day 30 for related HSCT or from day 50 for unrelated HSCT. In total, we began tapering CsA in 36, and classified them into 2 an “On-schedule group” or “Delayed group” based on the timing of starting tapering. The cumulative incidences of grade II-IV acute GVHD overall were 33.8% and 39.4% (P = 0.746) in the On-schedule and Delayed groups. The On-schedule group showed no significant difference in non-relapse mortality, but showed a trend toward a higher relapse rate, resulting in significantly worse overall survival (55.6% vs 72.2% at 1y, P = 0.025) and worse disease-free survival (38.9% vs 66.7% at 1y, P = 0.059). These findings suggest that early CsA tapering after HSCT in high-risk patients was not effective.