Peripheral blood stem cell transplantation (PBSCT) from HLA-identical sibling donors has been associated with poorer survival outcomes than bone marrow transplantation (BMT), suggesting increased non-relapse mortality (NRM) due to acute or chronic graft-versus-host disease (GVHD). This retrospective study compared the outcomes of tacrolimus versus cyclosporine for GVHD prophylaxis in patients receiving PBSCT from HLA-identical sibling donors. The medical records of 59 adult patients with hematologic malignancies who received their first PBSCT between January 2005 and August 2014 were retrospectively analyzed. The adjusted multivariate analyses showed significant reductions in grade Ⅱ-Ⅳ acute GVHD (hazard ratio [HR], 0.16) and all-grade chronic GVHD (HR, 0.42) with tacrolimus. In contrast, no significant reductions in grade Ⅲ-Ⅳ acute GVHD, intermediate to severe chronic GVHD, or non-relapse mortality were observed. Our results supported the superiority of tacrolimus in acute and chronic GVHD prophylaxis but failed to show survival benefit. This suggests that conditions besides GVHD might be contributing to inferior outcomes with PBSCT or that GVHD prophylaxis with tacrolimus is not sufficiently intensive to prevent lethal GVHD. Randomized prospective trials are necessary to validate the superiority of tacrolimus in PBSCT from HLA-identical sibling donors.
2017 The Japan Society for Hematopoietic Stem Cell Transplantation