Effect of early posttransplantation tacrolimus concentration on the development of acute graft-versus-host disease after cord blood transplantation

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 We retrospectively evaluated the effect of blood tacrolimus concentration early after cord blood transplantation (CBT) on acute graft-versus-host disease (GVHD). Twenty-eight patients who underwent CBT and received continuous tacrolimus infusion were included. The mean concentration of tacrolimus during the second week (17.8±3.7ng/mL in 0-Ⅰ versus 12.6±3.7 in Ⅱ-Ⅳ; P<.01) after CBT was significantly associated with gradeⅡ-Ⅳ acute GVHD. On the receiver operator characteristic curves, a cutoff value of 15ng/mL during the second week, provided the best balance between sensitivity and specificity. Multivariate analysis demonstrated that a mean tacrolimus concentration<15ng/mL during the second week was a significant risk factor for gradeⅡ-Ⅳ acute GVHD (hazard ratio, 0.22; 95% confidence interval, 0.07-0.69; P<.01). Early post-CBT tacrolimus concentration has a significant impact on the development of gradeⅡ-Ⅳ acute GVHD.