Journal article
Clinical outcomes of patients receiving three versus four doses of methotrexate with concomitant antithymocyte globulin in match unrelated donor allogeneic stem cell transplant: A single-center experience
EJHaem, Vol.5(3), pp.578-583
06/2024
DOI: 10.1002/jha2.909
PMCID: PMC11182390
PMID: 38895065
Appears in UI Libraries Support Open Access
Abstract
Methotrexate (MTX) doses on days +1, +3, +6, and +11 after match unrelated donor allogeneic stem cell transplant (MUD HSCT) is a common graft-versus-host disease (GVHD) prophylaxis regimen. However, the overlapping toxicity of MTX with conditioning chemotherapy sometimes warrants the omission of the fourth dose of MTX. Prior single-institution studies showed conflicting results comparing the outcomes of patients who received three versus four doses of MTX, but to our knowledge, the effect of concomitant antithymocyte globulin (ATG) has not been reported. Charts of patients who underwent MUD HSCT between 2009 and 2023 were reviewed. Patients received rabbit ATG (Thymoglobulin), given at 0.5 mg/kg on day -3, 2 mg/kg on day -2, and 2.5 mg/kg on day -1. MTX is given at 15 mg/m(2) on day +1 and 10 mg/m(2) on days +3, +6, and +11. Severe mucositis was the most common indication for day +11 MTX omission (82%). We identified 292 patients (116 in 3 dose cohort and 176 in 4 dose cohort). Median follow-up was 23 months (range 1-151). Patients in the 4 doses cohort were more frequently male (68% vs. 50%, p < 0.01), received a reduced intensity conditioning regimen (38.0% vs. 22%, p < 0.01), were older (median 58 vs. 54 years, p = 0.02), and received a transplant in the earlier era (median HSCT year 2014 vs. 2018, p < 0.01). A statistically significant difference was not evidenced between the cohorts for the following outcomes: acute GVHD (aGVHD) (HR 1.1, 95% CI 0.9-1.5), chronic GVHD (cGVHD) (HR 1.3, 95% CI 0.8-1.6), relapse-free survival (RFS) (HR 1.0, 95% CI 0.6-1.5), non-relapse mortality (NRM) (HR 1.4, 95% CI 0.9-2.2), and overall survival (OS) (HR 1.2, 95% CI 0.9-1.7). Both cohorts had similar median time to neutrophil engraftment at 14 days. When ATG is incorporated, omission of day +11 MTX does not significantly impact the rate of engraftment or cumulative incidence of aGVHD, cGVHD, RFS, NRM, and OS.
Details
- Title: Subtitle
- Clinical outcomes of patients receiving three versus four doses of methotrexate with concomitant antithymocyte globulin in match unrelated donor allogeneic stem cell transplant: A single-center experience
- Creators
- Kittika Poonsombudlert - University of Iowa Hospitals and ClinicsSarah Mott - University of IowaBenda Miller - University of Iowa Hospitals and ClinicsRatdanai Yodsuwan - University of IowaHira Shaikh - University of IowaChristopher Strouse - University of Iowa Hospitals and ClinicsJonathan Lochner - University of IowaUmar Farooq - University of IowaMargarida Magalhaes-Silverman - Univ Iowa Hosp & Clin, Holden Comprehens Canc, 200 Hawkins Dr C32GH, Iowa City, IA 52242 USA
- Resource Type
- Journal article
- Publication Details
- EJHaem, Vol.5(3), pp.578-583
- Publisher
- Wiley
- DOI
- 10.1002/jha2.909
- PMID
- 38895065
- PMCID
- PMC11182390
- ISSN
- 2688-6146
- eISSN
- 2688-6146
- Number of pages
- 6
- Language
- English
- Electronic publication date
- 04/28/2024
- Date published
- 06/2024
- Academic Unit
- Hematology, Oncology, and Blood & Marrow Transplantation; Internal Medicine
- Record Identifier
- 9984628220602771
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