Tacrolimus in hematopoietic stem cell transplantation

Background: Graft-versus-host disease (GVHD) associated with allogeneic peripheral blood or marrow transplantation is a serious life-threatening complication. Most of the available literature support the use of tacrolimus as a prophylactic agent for acute GVHD. Objective: To review the pharmacology, efficacy and safety of tacrolimus and recommend its place in therapy for the prophylaxis of GVHD. Methods: We conducted a literature search using PubMed/Medline (January 1996 – December 2008) using the keywords tacrolimus, graft-versus-host disease and hematopoietic stem cell transplantation. Data provided by the manufacturer and the FDA were also reviewed. Conclusion: Tacrolimus is effective in the prevention of acute GVHD. Trials comparing tacrolimus with cyclosporine using tacrolimus levels in the 7 – 10 ng/ml range and with larger numbers of patients may be necessary to better understand the impact of these drugs on survival.