An efficacy of interferon-α (IFN-α) and interleukin-2 (IL-2) in the treatment of hematological malignancies relapse-persistence-progression after the allogeneic nonmyeloablative stem cell transplantation (NSCT)
Biology of Blood and Marrow Transplantation
developed grade II to IV AGVHD, and 15 (20%) developed grades III to IV AGVHD. In univariate analysis, advanced diseases, donor and recipient age were significant risk factors for developing AGVHD. On the other hand, omitting day 11 MTX, Class I and/or Class II HLA allele disparities, CMV seropositivity, or sex mismatch were not identified as risk factors. The mean blood level of tacrolimus during the first three weeks were significantly lower in those who developed grade II to IV or III to IV
... to IV or III to IV AGVHD than that of patients who did not (17.5 vs.15..8 vs.15.3 p ϭ 0.007, p ϭ 0.015), and the level Ͼ15ng/ml during the third week was associated with the occurrence of moderate or severe AGVHD(p ϭ 0.023). In multivariate analysis, only the mean concentration of tacrolimus remained as a risk factor to develop moderate to severe AGVHD. The incidence of nephrotoxicity (doubling of serum creatinine) or hyperglycemia (BS Ͼ 200mg/dl) did not significantly correlate with the mean blood level of tacrolimus until three weeks after transplant; however, the incidence of those events significantly correlated with the tacrolimus blood level of a week before the events thereafter (p ϭ 0.0001). These data suggest the importance of maintaining tacrolimus blood level above 15 ng/ml during the first three weeks after transplantation to optimize the efficacy while minimize its side effects.