Tacrolimus versus cyclosporin A in AML

In patients with acute myeloid leukaemia (AML) who are in first complete remission undergoing T-cell replete haematopoietic cell transplantation (HCT) with either haploidentical or unrelated donors, tacrolimus or cyclosporine A combined with post-transplantation cyclophosphamide (PTCy) and mycophenolate mofetil (MMF) resulted in similar overall survival (OS) and graft-versus-host disease (GvHD)-free, relapse-free survival (GRFS) outcomes. However, tacrolimus was associated with a decreased risk of acute GvHD compared with cyclosporine A in the subset of patients with haploidentical donors.

“In patients with AML who are in first complete remission undergoing T-cell replete HCT and PTCy, it is unknown whether the choice of calcineurin inhibitor influences outcomes,” said Dr Gesine Bug (Goethe University Frankfurt, Germany) [1]. Therefore, Dr Bug and colleagues retrospectively compared GvHD prophylaxis cyclosporine A with tacrolimus, in combination with PTCy and MMF in a cohort of participants with AML in first complete remission (n=2,427). The main outcomes of the study were OS, the cumulative incidence of relapse and relapse-free survival, and the cumulative incidence of acute and chronic GvHD and GRFS.

Participants in the cyclosporine A group (n=1,528) were more likely to have a haploidentical donor than participants in the tacrolimus group (n=899; 81% vs 67%; P<0.0001). Also, 31% of the participants in the cyclosporine A group received bone marrow compared with 16% of the participants in the tacrolimus group (P<0.0001). No difference was observed in OS between the 2 study groups, with 3-year OS rates of 66.3% and 64.5% (P=0.75). A multivariate analysis showed that within the subgroup of patients with haploidentical donors (n=1,844), acute GvHD was more common in the cyclosporine A arm than in the tacrolimus arm (HR 0.64; 95% CI 0.42–0.98).

“These results suggest that tacrolimus may be the preferred calcineurin inhibitor to combine with PTCy-based immunosuppression in patients with AML in first complete remission undergoing HCT with a haploidentical donor,” concluded Dr Bug.

1. Bug G, et al. Use of cyclosporine A versus tacrolimus combined with post-transplantation cyclophosphamide for AML in first complete remission: A study from the acute leukemia working party (EBMT). OS01-06, European Society for Blood and Marrow Transplantation (EBMT) 49^th Annual Meeting, 23–26 April 2023, Paris, France.

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Posted on 14 June 202329 July 2024