Graft versus host disease (GvHD) Prophylaxis
Day -3 ...
138
Description

Graft versus host disease (GvHD) Prophylaxis

Day -3 to indefinite (tapered after months to years), goal is to prevent graft rejection & acute/chronic GVHD

Immunosuppression regimens: combined Tacrolimus/Methotrexate or Tacrolimus/Sirolimus most common; in haploidentical transplants, post-transplant cyclophosphamide (PTCy) and Tacro/Cellcept is used.

 • Tacrolimus (FK506): calcineurin inhibitor, goal trough: 5-10 ug/L

    - Toxicity: AKI, ↑K, ↓Mg, ↑LFTs, N/V, TMA, tremor, ↑risk of DM

 • Sirolimus (Rapamycin): mTOR inhibitor; goal trough 3-12 ug/L

    - Toxicity: AKI, Sinusoidal obstruction syndrome (SOS), leukopenia, TMA, HLD, TCP

 • Methotrexate (MTX): anti-metabolite (inhibit thymidine), given at D1,3,6,11 w/ cyclosporine or tacrolimus

    - Toxicity: mucositis, myelosuppression, hepatotoxicity, AKI

 • Mycophenolate (MMF/Cellcept): anti-metabolite (inhibits purine synthesis)

    - Toxicity: myelosuppression, N/V/D

 • Post-transplant cyclophosphamide (PTCy): days +3 and +4; kills early alloreactive T-cells T-cell depletion regimens: (ATG, decreased T-cell dose) no longer favored; decreased GVHD but no effect on OS



#GVHD #ppx #prophylaxis #management #pharmacology #transplant
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Account created for the MGH Internal Medicine Housestaff Manual "White Book" - https://stk10.github.io/MGH-Docs/WhiteBook-2019-2020.pdf
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