GvHD prophylaxis with tacrolimus, sirolimus, and mycophenolate mofetil after reduced intensity conditioning hematopoietic stem cell allogeneic transplantation
We present the largest prospective real-world experience in 159 patients who received the triple combination of tacrolimus/sirolimus/mycophenolate mofetil after reduced intensity conditioning allogeneic hematopoietic stem cell transplantation (RIC-alloHSCT) from matched-related (MRD), matched-unrelated (MUD) or mismatched-unrelated donors (MMURD). Despite the high-risk and elderly population, non-relapse mortality (NRM) at day +100 and 1 year was 5.1% and 8.6%. Grades 2-4 and 3-4 acute Graft-versus-host disease (GvHD) at day +180 was 30.3% and 13%, respectively. Chronic GvHD at 1 and 3 years was 23.2% and 41% and for moderate/severe was 13.2% and 26.6%, respectively. With a median follow-up of 20 months, the 1- and 3-year progression-free survival was 60% and 49%, the GvHD-free relapse-free survival was 44% and 32%, and the overall survival was 70.3% and 61%, respectively, for the entire cohort. Patients receiving allo-HSCT from MMURD showed a higher incidence of aGvHD with impact on survival endpoints. GvHD prophylaxis with the triple-drug combination tacrolimus/sirolimus/mycophenolate mofetil showed excellent results in terms of NRM, GvHD and survival in a high-risk, frail and elderly population in the context of RIC-HSCT from MRD and MUD. The subgroup of patients receiving RIC-HSCT from MMURD might probably benefit from other prophylaxis strategies.
Authors
- Mónica Cabrero (ORCID: https://orcid.org/0000-0001-7586-4792)
- Elena Soria‐Saldise
- Misael Cortés Rodríguez (ORCID: https://orcid.org/0000-0003-3407-1635)
- Nancy Rodríguez-Torres
- Á. López (ORCID: https://orcid.org/0000-0002-7175-8084)
- A. Cabero Martínez
- M. Baile González
- Ildefonso Espigado (ORCID: https://orcid.org/0000-0002-4043-6613)
- Miriam López-Parra (ORCID: https://orcid.org/0000-0002-2949-0627)
- Lucía López‐Corral (ORCID: https://orcid.org/0000-0003-1908-5596)
- Virginia Escamilla Gómez (ORCID: https://orcid.org/0000-0002-0639-574X)
- Cristina Blázquez Goñi (ORCID: https://orcid.org/0000-0002-4144-2281)
- Eduardo Rodríguez‐Arbolí (ORCID: https://orcid.org/0000-0002-2237-6733)
- Patricia Alcalde‐Mellado
- A. García Bacelar
- Estefanía Pérez‐López
- Alejandro Pita (ORCID: https://orcid.org/0000-0003-2972-3782)
- Almudena Navarro‐Bailón (ORCID: https://orcid.org/0000-0002-7972-5666)
- Josè Antonio Pérez-Simón (ORCID: https://orcid.org/0000-0003-3616-6101)
- R Parody-Porras
- Teresa Caballero‐Velázquez (ORCID: https://orcid.org/0000-0001-7487-3793)
- Francisco Martín-Domínguez (ORCID: https://orcid.org/0009-0004-7536-8907)
- J F Falantes-González
- Lourdes Vázquez (ORCID: https://orcid.org/0000-0001-8191-0046)
Institutions
- Universidad de Salamanca (ES)
- Instituto de Biomedicina de Sevilla (ES)
- Centro de Investigación del Cáncer (ES)
- Hospital Universitario Virgen del Rocío (ES)
Publication Details
- Journal
- Bone Marrow Transplantation
- Published
- 2025-04-08
- DOI
- https://doi.org/10.1038/s41409-025-02562-w
- Citations
- 1
- Primary Topic
- Hematopoietic Stem Cell Transplantation
- Type
- article
- Field-Weighted Citation Impact
- 1.77
Funders
- European Commission
- Instituto de Salud Carlos III