TAC Initial Steady State Level in PTCy GvHD Prophylaxis Regimen

Yao JM, Yang D, Clark MC, et al. Tacrolimus Initial Steady State Level in Post-Transplant Cyclophosphamide-Based GvHD Prophylaxis Regimen. Bone Marrow Transplantation. 2021; (doi: 10.1038/s41409-021-01528-y).

Administering tacrolimus (TAC) at initial steady state (TISS) of <10 ng/mL for graft versus host disease (GVHD) prophylaxis early after hematopoietic cell transplantation with post-transplant cyclophosphamide (PTCy) reduced the risk of viral infection and toxicities compared with higher serum levels of TAC. For the retrospective study, researchers assessed a consecutive case series of 210 patients who received PTCy/TAC-based prophylaxis post-HCT from January 2013 to June 2018. HCT from haploidentical (N=172) or mismatched donors (N=38) plus flat dose (FD) or weight-based dose (WBD) TAC. At 24 months, overall survival (OS), disease-free survival (DFS), and relapse rate (RR) were 61%, 56%, and 22%, respectively in 176 TISS <10 ng/mL recipients, versus respective rates of 50%, 43%, and 35% in 34 TISS ≥10 ng/mL recipients. Multivariable analysis revealed similar OS, DFS, RR, non-relapse mortality, acute GvHD grade II–IV, grade III–IV, or chronic GvHD by TISS. Viral infection was more likely with TISS ≥10 ng/mL Compared with patients who received WBD, more patients who received FD had TISS <10 ng/mL.

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