Please use this identifier to cite or link to this item: https://ahro.austin.org.au/austinjspui/handle/1/33223
Title: Predictors and outcomes of dose reduction of methotrexate and cyclosporin graft-versus-host disease prophylaxis following allogeneic haemopoietic cell transplantation.
Austin Authors: Ramanan, Radha;Lim, Andrew Boon Ming ;Tan, Joanne L C;Barmanray, Rahul D;Mason, Kate;Collins, Jenny;Hillman, Matthew;Szer, Jeff;Bajel, Ashish;Ritchie, David
Affiliation: Department of Clinical Haematology, Peter MacCallum Cancer Centre
Olivia Newton-John Cancer Research Institute
Department of Haematology, Alfred Health, Melbourne, Victoria, Australia.
Department of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia.
Clinical Haematology
The Royal Melbourne Hospital, Melbourne, Victoria, Australia.
Department of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia.
Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia.
Department of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia.
Issue Date: Jun-2023
Date: 2022
Publication information: Internal Medicine Journal 2023-06; 53(6)
Abstract: Concern regarding dose-related toxicities of methotrexate (MTX) and cyclosporin (CYA) graft-versus-host disease (GVHD) prophylaxis occasionally leads to dose alterations post allogeneic haemopoietic cell transplant (alloHCT). To clarify causes of MTX and CYA dose alteration and assess impact on patient outcomes, including GVHD, relapse, non-relapse mortality (NRM) and overall survival (OS). Analysis of retrospective data was performed in a single tertiary centre of patients who underwent alloHCT for any indication and who received GVHD prophylaxis with CYA and MTX between the years 2011 and 2015. Univariate analysis was conducted using the log-rank test for OS and using competing risk regression for NRM, relapse and GVHD. Fisher exact tests were used to determine if an association existed between each of the pre-transplant variables and MTX alteration. Multivariate models for OS and NRM were constructed using Cox proportional hazards modelling and competing risk regression respectively. Fifty-four (28%) of 196 had MTX alterations and 61/187 (33%) had CYA alterations. Reasons for MTX alteration included mucositis, renal or liver impairment, fluid overload and sepsis. Causes of CYA alteration were numerous, but most commonly due to acute kidney impairment. MTX alteration was associated with inferior OS (hazard ratio 2.4; P = <0.001) and higher NRM (odds ratio (OR) 4.6; P < 0.001) at 6 years post-landmark. CYA alteration was associated with greater NRM (OR 2.7; P = 0.0137) at 6 years. GVHD rates were unaffected by dose alteration. Our findings suggest dose alteration in MTX and CYA GVHD prophylaxis is associated with adverse survival outcomes in alloHCT, without a significant impact on GVHD rates.
URI: https://ahro.austin.org.au/austinjspui/handle/1/33223
DOI: 10.1111/imj.15829
ORCID: 0000-0001-5539-0673
0000-0002-5751-6900
0000-0002-1433-2239
0000-0001-6783-2301
Journal: Internal Medicine Journal
Start page: 951
End page: 960
PubMed URL: 35666197
ISSN: 1445-5994
Type: Journal Article
Subjects: allogeneic
cyclosporin
graft-versus-host disease
haemopoietic
methotrexate
transplant
Methotrexate/adverse effects
Cyclosporine/adverse effects
Hematopoietic Stem Cell Transplantation/adverse effects
Graft vs Host Disease/prevention & control
Graft vs Host Disease/etiology
Appears in Collections:Journal articles

Show full item record

Page view(s)

36
checked on May 17, 2024

Google ScholarTM

Check


Items in AHRO are protected by copyright, with all rights reserved, unless otherwise indicated.