Drug monitoring for mycophenolic acid in graft-vs-host disease prophylaxis in cord blood transplantation

Abstract

Aims: We performed the retrospective analysis to clarify the significance of drug monitoring for mycophenolic acid (MPA), the active form of mycophenolate mofetil (MMF), in prophylaxis for graft-vs-host disease (GVHD) in cord blood transplantation. Methods: We retrospectively analysed the data of 46 patients who underwent first cord blood transplantation and received GVHD prophylaxis with tacrolimus plus MMF. MPA levels were measured on days 7 and 21, and 24-hour areas under the curve (AUC0–24) were estimated. Results: The engraftment and 3-year overall survival rates of all patients were 94% and 78%, respectively. The cumulative incidence of sepsis before engraftment was higher in patients with AUC0–24 on day 7 of >60 μg h/mL than in other patients (33 vs 6%, P =.02). The cumulative incidence of grade II–IV acute GVHD was higher in patients with AUC0–24 on day 21 of ≤30 μg h/mL than in other patients (80 vs 50%, P =.04). The cumulative incidence of human herpesvirus 6 reactivation was higher in patients with AUC0–24 on day 21 of ≤48 μg h/mL (median) than in other patients (50 vs 19%, P =.03). Conclusion: Blood level of MPA was associated with risk of acute GVHD and infection. A prospective trial evaluating the benefit of personalized MMF dosing using MPA levels is needed.