MMF dose optimization for GvHD prophylaxis in UCBT

Results from a retrospective study examining optimal mycophenolate mofetil (MMF) dosing for graft-versus-host disease (GvHD) prophylaxis in patients with non-remission myeloid malignancies receiving umbilical cord blood transplantation (UCBT; N = 574) were recently published in Transplantation and Cellular Therapy by Yamamoto et al.

Key data: High-dose MMF (≥23 mg/kg/day) impaired engraftment and increased early non-relapse mortality (NRM) compared with lower doses. Early NRM was primarily due to bacterial infections in the MMF-High group, with Day 28 NRM rates of 12.4% (MMF-High), 2.1% (MMF-Low; <17 mg/kg/day), and 4.7% (MMF-Int; MMF 17–23 mg/kg/day) (p = 0.002). No significant difference in relapse or acute GvHD across MMF dose groups was observed.

Key learning: Careful optimization of MMF dosing may improve early transplant outcomes in patients undergoing UCBT for advanced myeloid malignancies, with high-dose immunosuppression associated with impaired engraftment and risk for early NRM.