Early Administration of Calcineurin Inhibitors and MMF Improves Cytokine Release Syndrome

By Dustin Samples - September 6, 2023

In haploidentical allogeneic hematopoietic stem cell transplantation (haplo-HSCT), a critical aspect of the post-transplantation treatment regimen involves the use of calcineurin inhibitors (CNIs) and mycophenolate mofetil (MMF) following post-transplantation cyclophosphamide (PTCy). This approach aims to maintain PTCy-induced tolerance while mitigating complications. However, the implications of administering CNIs and MMF before PTCy, especially concerning cytokine release syndrome (CRS) and overall transplantation outcomes, have been insufficiently explored.

A study presented at the 11th Annual Meeting of the Society of Hematologic Oncology (SOHO), Houston, Texas, aimed to determine the incidence and severity of CRS, graft-versus-host disease (GVHD), and survival outcomes in patients undergoing haplo-HSCT who received CNIs and MMF before PTCy.

The analysis comprised 41 patients (median age, 41 years) with hematological malignancies undergoing haplo-HSCT. There was a notably high risk in 59% of patients. Approximately 61% of individuals received myeloablative conditioning, while stem cells were primarily collected from peripheral blood in 97.5% of cases.

Fifty-four percent of patients developed CRS, predominantly grade 1 in severity, with only 1 patient experiencing grade 2 CRS. The cumulative incidences of grade II-IV acute GVHD, grade IV acute GVHD, and moderate to severe chronic GVHD were 34.1%, 7.3%, and 14.6%, respectively.

The 21-month follow-up period revealed a 3-year overall survival rate of 67%, while disease-free survival rates at 100 days and 3 years stood at 90.3% and 53.4%, respectively. The 3-year cumulative incidence of relapse was 26.6%, with a median time to relapse of 217 days. Notably, the 3-year non-relapse mortality (NRM) was 22%.

“Our results suggest that earlier administration of CNIs and MMF in haplo-HSCT may reduce the incidence and severity of CRS without increasing the risk of relapse, GVHD, or NRM,” the authors concluded.


Ma’koseh M, Halahleh K, Yaseen A, et al. Impact of Earlier Administration of Calcineurin Inhibitors in Haploidentical Stem Cell Transplantation on Cytokine Release Syndrome and Transplantation Outcomes. Abstract CT-405. Presented at the 11th Annual Meeting of the Society of Hematologic Oncology; September 6-9, 2023; Houston, Texas.

Post Tags:SOHO 2023: GVHD