A high risk of life-threatening infectious complications in mycophenolate mofetil treatment for acute or chronic graft-versus-host disease

• Published in: International journal of hematology Vol. 91; no. 3; pp. 464 - 470
• Main Authors: Onishi, Chie, Ohashi, Kazuteru, Sawada, Takeshi, Nakano, Mikako, Kobayashi, Takeshi, Yamashita, Takuya, Akiyama, Hideki, Sakamaki, Hisashi
• Format: Journal Article
• Language: English
• Published: Japan Springer Japan 01.04.2010; Springer; Springer Nature B.V
• Subjects: Acute Disease; Adult; Anemia, Aplastic - immunology; Anemia, Aplastic - mortality; Anemia, Aplastic - therapy; Biological and medical sciences; Chronic Disease; Female; Graft vs Host Disease - drug therapy; Graft vs Host Disease - immunology; Graft vs Host Disease - mortality; Hematologic and hematopoietic diseases; Hematology; Humans; Immunocompromised Host; Immunosuppressive Agents - administration & dosage; Immunosuppressive Agents - adverse effects; Infection - etiology; Infection - mortality; Leukemia, Myelogenous, Chronic, BCR-ABL Positive - immunology; Leukemia, Myelogenous, Chronic, BCR-ABL Positive - mortality; Leukemia, Myelogenous, Chronic, BCR-ABL Positive - therapy; Leukemia, Myeloid, Acute - immunology; Leukemia, Myeloid, Acute - mortality; Leukemia, Myeloid, Acute - therapy; Male; Medical sciences; Medicine; Medicine & Public Health; Middle Aged; Mycophenolic Acid - administration & dosage; Mycophenolic Acid - adverse effects; Mycophenolic Acid - analogs & derivatives; Myelodysplastic Syndromes - immunology; Myelodysplastic Syndromes - mortality; Myelodysplastic Syndromes - therapy; Oncology; Original Article; Precursor Cell Lymphoblastic Leukemia-Lymphoma - immunology; Precursor Cell Lymphoblastic Leukemia-Lymphoma - mortality; Precursor Cell Lymphoblastic Leukemia-Lymphoma - therapy; Retrospective Studies; Risk Factors; Stem Cell Transplantation - adverse effects; Stem Cell Transplantation - mortality; Survival Analysis; Transplantation, Homologous; Young Adult; Graft-versus-host disease; Infectious complication; Mycophenolate mofetil; Allogeneic stem cell transplantation; Life-threatening; Immunopathology; Graft versus host disease; High risk; Hematology; Enzyme; Chronic disease; Acute; Stem cell; IMP dehydrogenase; Enzyme inhibitor; Hematopoietic cell; Homograft; Infection; Treatment; Infectious risk; Graft; Complication; Oxidoreductases
• ISSN: 0925-5710; 1865-3774
• DOI: 10.1007/s12185-010-0516-x

We describe herein the clinical courses and outcomes of 26 patients who received oral mycophenolate mofetil (MMF) for the treatment of steroid-resistant refractory or steroid-dependent acute or chronic graft-versus-host disease (GVHD) in a single institution. In most cases, 1,500 mg/day of MMF is a median dose (range 500–3,000 mg/day) and administered for 116.5 days (range 9–584 days) along with calcineurin inhibitors and steroids. Although 20 patients (77%) showed rapid improvement of GVHD symptoms, of 15 patients, 13 (87%) showed acute GVHD; of 11 patients, 7 (64%) showed chronic GVHD; most patients (54%) experienced infection during MMF administration, including 5 cases with life-threatening infection. Positive cytomegalovirus (CMV) antigenemia was also observed in 19 patients (73%), but no patients developed CMV infection. Within the median follow-up of 12.5 months (range 0.5–67 months), 10 patients (39%) died. This small study demonstrates that MMF offers an alternative tool for rescuing steroid-refractory or steroid-dependent GVHD, but increases the risk of developing life-threatening infection.