Methotrexate Prophylaxis Shows Favorable Survival Benefits in Allogeneic Hematopoietic Cell Transplantation

Strategic Insights -

Researchers at the University Hospital Tubingen conducted a retrospective analysis on the effectiveness of methotrexate (MTX) versus mycophenolate mofetil (MMF) prophylaxis in allogeneic hematopoietic cell transplantation (allo-HCT) for chronic myeloid malignancies. The study, which analyzed 13,699 patients from 321 centers, found that MTX prophylaxis was associated with reduced overall mortality and non-relapse mortality compared to MMF prophylaxis. The research also concluded that MTX-complemented CNI prophylaxis was associated with favorable survival after acute graft-versus-host disease (GVHD) compared to MMF.

Key Takeaways:

  • The study included 13,699 patients from 321 centers who received either MTX or MMF prophylaxis in combination with a calcineurin inhibitor (CNI).
  • MTX prophylaxis was associated with reduced overall mortality (HR 0.87, 95% CI 0.81-0.95, p = 0.001) and non-relapse mortality (HR 0.86, 95% CI 0.78-0.96, p = 0.006) compared to MMF prophylaxis.
  • There was no significant association of prophylaxis with risk of relapse or relapse-free survival (RFS).
  • The study found a reduced risk of Grades 2-4 acute GVHD and reduced mortality after acute GVHD with MTX prophylaxis.
  • The research concluded that MTX-complemented CNI prophylaxis was associated with favorable survival and favorable survival after aGVHD compared to MMF.

Statistics:

  • 13,699 patients from 321 centers were analyzed in the study.
  • Median follow-up was 42.8 months (IQR 19.8-74.5 months).
  • The study found a 13% reduction in overall mortality with MTX prophylaxis compared to MMF prophylaxis (HR 0.87, 95% CI 0.81-0.95).
  • The study found a 14% reduction in non-relapse mortality with MTX prophylaxis compared to MMF prophylaxis (HR 0.86, 95% CI 0.78-0.96).
  • There was no significant association of prophylaxis with risk of relapse (p = 0.53) or RFS (p = 0.12).

Sources:

  • Methotrexate Versus Mycophenolate Mofetil Prophylaxis in Allogeneic Hematopoietic Cell Transplantation for Chronic Myeloid Malignancies: A Retrospective Analysis on Behalf of the Chronic Malignancies Working Party of the EBMT. American Journal of Hematology, 2024,100(1).
  • https://doi-org.sdpl.idm.oclc.org/10.1002/ajh.27531.