Continuous Versus Intermittent Tacrolimus for GVHD Prophylaxis

By Dustin Samples - Last Updated: February 21, 2023

Tacrolimus is a standard prophylactic agent for graft-versus-host disease in patients undergoing allogeneic hematopoietic stem cell transplant. Typically, it is administered continuously in intravenous (IV) doses of 0.03 mg/kg/day based on ideal body weight (IBW). Due to logistical constraints and pump failures, researchers at the Aurora St. Luke’s Medical Center, Milwaukee, Wisconsin, implemented an intermittent dose regiment for GHVD prophylaxis with tacrolimus. They presented their results at the 2023 Tandem Transplant and Cellular Therapy Meetings of the ASTCT and CIBMTR.

After performing a literature review, Aurora St. Luke’s Medical Center began using intermittent intravenous (IIV) tacrolimus at a starting dose of 0.015 mg/kg twice daily over 4 hours using IBW. Between January 1, 2020, and September 12, 2022, 23 patients received continuous intravenous (CIV) tacrolimus, and 17 received IIV tacrolimus for GVHD prophylaxis. The patient groups were compared for nephrotoxicity, neurotoxicity, incidence of acute GVHD, grade of acute GVHD, day 100 disease status, day 100 survival, tacrolimus levels, and days to neutrophil and platelet engraftment.

One patient in the IIV group developed nephrotoxicity, as did 2 in the CIV group, but this difference was not statistically significant. None of the patients demonstrated neurotoxicity. Among the other outcome measures, the 2 groups had no significant differences.

The 1 difference between the 2 groups was the tacrolimus level, which the researchers attributed to increased vigilance: “The only statistically significant finding was an increase in tacrolimus doses in the IIV group; due to its implementation, closer monitoring was warranted initially, hence a higher number of levels in the IIV group.”

These results are encouraging because they support a regimen that alleviates the burden of administration and logistical concerns.

Williams M, Mejaki B, Graff J, et al. Comparison of Intermittent Intravenous Tacrolimus to Continuous Tacrolimus in Allogeneic Stem Cell Transplant Recipients. Abstract #358. Presented at the 2023 Tandem Meetings of ASTCT and CIBMTR; February 15-19, 2023; Orlando, FL.

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