Tacrolimus versus Cyclosporine after Hematopoietic Cell Transplantation for Acquired Aplastic Anemia

Yoshihiro Inamoto*, Mary E.D. Flowers, Tao Wang, Alvaro Urbano-Ispizua, Michael T. Hemmer, Corey S. Cutler, Daniel R. Couriel, Amin M. Alousi, Joseph H. Antin, Robert Peter Gale, Vikas Gupta, Betty K. Hamilton, Mohamed A. Kharfan-Dabaja, David I. Marks, Olle T.H. Ringdén, Gérard Socié, Melhem M. Solh, Görgün Akpek, Mitchell S. Cairo, Nelson J. ChaoRobert J. Hayashi, Taiga Nishihori, Ran Reshef, Ayman Saad, Ami Shah, Takanori Teshima, Martin S. Tallman, Baldeep Wirk, Stephen R. Spellman, Mukta Arora, Paul J. Martin

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

13 Scopus citations


Combinations of cyclosporine (CSP) with methotrexate (MTX) have been widely used for immunosuppression after allogeneic transplantation for acquired aplastic anemia. We compared outcomes with tacrolimus (TAC)+MTX versus CSP+MTX after transplantation from HLA-identical siblings (SIB) or unrelated donors (URD) in a retrospective cohort of 949 patients with severe aplastic anemia. Study endpoints included hematopoietic recovery, graft failure, acute graft-versus-host disease (GVHD), chronic GVHD, and mortality. TAC+MTX was used more frequently in older patients and, in recent years, in both SIB and URD groups. In multivariate analysis, TAC+MTX was associated with a lower risk of mortality in URD recipients and with slightly earlier absolute neutrophil count recovery in SIB recipients. Other outcomes did not differ statistically between the 2 regimens. No firm conclusions were reached regarding the relative merits of TAC+MTX versus CSP+MTX after hematopoietic cell transplantation for acquired aplastic anemia. Prospective studies would be needed to determine whether the use of TAC+MTX is associated with lower risk of mortality in URD recipients with acquired aplastic anemia.

Original languageEnglish (US)
Pages (from-to)1776-1782
Number of pages7
JournalBiology of Blood and Marrow Transplantation
Issue number10
StatePublished - Oct 1 2015


  • Aplastic anemia
  • Cyclosporine
  • Graft-versus-host disease
  • Hematopoietic cell transplantation
  • Immunosuppression
  • Tacrolimus

ASJC Scopus subject areas

  • Transplantation
  • Hematology


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