• Hiroshi Yagasaki, Seiji Kojima, Hiromasa Yabe, Koji Kato, Hisato Kigasawa, Hisashi Sakamaki, Masahiro Tsuchida, Shunichi Kato, Takakaza Kawase, Hideki Muramatsu, Yasuo Morishima, and Yoshihisa Kodera.
• Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan.
• Biol. Blood Marrow Transplant. 2009 Dec 1; 15 (12): 1603-8.

AbstractTacrolimus (FK) and cyclosporine (CsA) have been shown to be effective in the prophylaxis of graft-versus-host disease (GVHD). However, no comparative studies have yet been conducted to examine the efficacy of FK/methotrexate (MTX) and CsA/MTX in patients with severe aplastic anemia (SAA) given unrelated donor bone marrow transplantation (U-BMT). We used matched-pair analysis to compare FK/MTX with CsA/MTX in patients with SAA who received U-BMT through the Japan Marrow Donor Program. Forty-seven pairs could be matched exactly for recipient age and conditioning regimens. Forty-five patients achieved engraftment in the FK group and 42 patients in the CsA group. The probability of grade II-IV acute GVHD (aGVHD) was 28.9% in the FK group and 32.6% in the CsA group (P=.558). The probability of chronic GVHD (cGVHD) was 13.3% in the FK group and 36.0% in the CsA group (P=.104). The 5-year survival rate was 82.8% in the FK group and 49.5% in the CsA group (P=.012). The study shows the superiority of FK/MTX over CsA/MTX in overall survival because of the lower incidence of transplantation-related deaths. A prospective randomized study comparing FK/MTX and CsA/MTX is warranted.

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