GVHD prophylaxis before an allogeneic transplant – pro
Transplantation for AML is well accepted by guidelines for poor prognosis AML, which this is by the virtue of being monocytic and therapy related. However, the use of tacrolimus and sirolimus is of failry recent origin and is not recommended by guidelines. It si supported by phase II studies, and differetn combinations of drugs were studied in these trials. They usually consisted of combinations of a calcineurin inhibitor with an additional agent such as methotrexate, mycophenolate or sirolimus.
Roberto Rodriguez, Ryotaro Nakamura, Joycelynne M. Palmer, Pablo Parker, Sepideh Shayani, Auyaporn Nademanee, David Snyder, Vinod Pullarkat, Neil Kogut, Joseph Rosenthal, Eileen Smith, Chatchada Karanes, Margaret O’Donnell, Amrita Y. Krishnan, David Senitzer and Stephen J. Forman
Blood 2010 115:1098-1105;
Davies JK, Lowdell MW. New advances in acute graft-versus-host disease prophylaxis. Transfus Med. 2013;13:387–397
Alyea EP, Li S, Kim AT, et al. Sirolimus, tacrolimus, and low-dose methotrexate as graft-versus-host disease prophylaxis in related and unrelated donor reduced-intensity conditioning allogeneic peripheral blood stem cell transplantation. Biol Blood Marrow Transplant 2008;14(8):920-926.
Dipenkumar Modi, Wei Chen, Jang Hyejeong, Abhinav Deol, Lois Ayash, Alavi Asif, Divaya Bhutani, Kendra Mellert, Voravit Ratanatharathorn and Joseph P. UbertiA Phase II Study of Tacrolimus and Thymoglobulin, As Graft-Versus-Host-Disease Prophylaxis in Patients Undergoing Related Donor Allogeneic Hematopoietic Cell Transplantation Blood 2016 128:4579;