Tacrolimus for prevention of graft-versus-host disease after mismatched unrelated donor cord blood transplantation

Ten children with hematologic malignancies or a storage disease underwent t ransplantation using cord blood cells from an unrelated donor mismatched fo r 1 (n = 7) or 2 (n = 3) HLA antigens, The median total nucleated cell dose was 4.0 (range, 2.2-7.1) x 10(7)/kg. GVHD prophylaxis consisted of tacroli mus dose-adjusted to maintain a whole blood level of 5-15 ng/ml with or wit hout methotrexate 5 mg/m(2) i.v. on days 1, 3, 6 and 11, Corticosteroids we re not administered prophylactically. Median follow-up is 12 months (range, 5-28 months). One patient had autologous recovery and subsequently relapse d 153 days post transplant, For the remainder of the patients, the median t ime to an ANC >0.5 x 10(9)/l was 21 days (range, 19-38 days), and the media n time to platelets >20 x 10(9)/l was 39 days (range, 21-97 days), The actu arial risk of grade 2 GVHD was 77% (95% CI, 49-100%), and no patient had gr ades 3-4 GVHD, Two patients developed chronic GVHD, The survival rate is 90 % (95% CI, 81-100%), The combination of tacrolimus and minidose methotrexat e is active for the prevention of severe but not moderate acute GVHD after mismatched unrelated donor cord blood transplantation.