GVHD PROPHYLAXIS USING TACROLIMUS ALONE FOLLOWING REDUCED-INTENSITY CORD BLOOD TRANSPLANTATION IN ADULT PATIENTS: RETROSPECTIVE ANALYSIS OF 39 PATIENTS WITH SPECIAL ATTENTION TO SERUM CONCENTRATION OF TACROLIMUS

• Published in: Japanese Journal of Transfusion and Cell Therapy Vol. 56; no. 3; pp. 359 - 364
• Main Authors: Ito, Tadaaki, Ino, Kanako, Nasu, Izumi, Minowa, Mayumi, Furusawa, Masako, Okuno, Yuri, Uchida, Yumiko, Tamura, Hiromi, Hasebe, Shinobu, Tuji, Masanori, Takagi, Shinsuke, Yamamoto, Hisashi, Mori, Yuki, Matsuno, Naofumi, Uchida, Naoyuki, Masuoka, Kazuhiro, Wake, Atsushi, Makino, Shigeyoshi, Miyakoshi, Shigesaburo, Taniguchi, Shuichi, Hayashi, Masahiro
• Format: Journal Article
• Language: Japanese
• Published: The Japan Society of Transfusion Medicine and Cell Therapy 2010
• Subjects: Concentration; Graft-versus-Host-Disease; Reduced intensity cord blood transplantation; Renal toxicity; Tacrolimus
• ISSN: 1881-3011; 1883-0625
• DOI: 10.3925/jjtc.56.359

The safety and efficacy of GVHD prophylaxis using tacrolimus alone following reduced-intensity cord blood transplantation were retrospectively assessed based on the tacrolimus whole blood concentration. Among 39 patients, toxicity profiles observed were renal (n=8, 20.5%), central nervous system (n=4, 10.3%), GI tract (n=2, 5.1%), and liver (n=2, 5.1%). Mean tacrolimus whole blood concentration of the previous 10 days in those who had renal damage was higher than those who did not (20.4 ng/ml vs. 14.8 ng/ml, P<0.05). The incidence of renal damage was 60.0% and 6.9% for those who showed tacrolimus whole blood concentrations of ≥17 ng/ml and < 17 ng/ml, respectively (P<0.05). The incidence of severe acute GVHD (grade II-IV) was 27.7%, suggesting the effectiveness of single tacrolimus prophylaxis. In those who showed a tacrolimus whole blood concentration above 17 ng/ml, no acute GVHD was observed, suggesting the potential advantage of maintaining higher a whole blood concentration of tacrolimus to reduce the incidence and severity of GVHD. Thus, it is suggested that the toxicity and efficacy of tacrolimus were dose-dependent, and that close monitoring of tacrolimus whole blood concentration is of particular importance both to reducing toxicity and increasing safety.