Impact of early tacrolimus exposure on outcomes after allogeneic hematopoietic cell transplantation for acute myeloid leukemia and myelodysplastic syndromes

P. S. Jäger; Andreas Alexander Ralfs; Felicitas Schulz; Nora Liebers; Jonathan Bobak; Ben‐Niklas Baermann; Sören Twarock; Alexander Hölscher; Kathrin Nachtkamp; Annika Kasprzak; Joonatan Lavikka; Felix Matkey; Titus Watrin; Malika El Yaouti; Ulrich Germing; Sascha Dietrich; Guido Kobbe

doi:10.1007/s00277-026-06988-0

April 9, 2026Annals of HematologyOpen Access

Impact of early tacrolimus exposure on outcomes after allogeneic hematopoietic cell transplantation for acute myeloid leukemia and myelodysplastic syndromes

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Key Points

The aim is to evaluate how early exposure to tacrolimus affects the outcomes of patients undergoing allogeneic transplantation for acute myeloid leukemia and myelodysplastic syndromes.
Conducted in a uniform setting with matched unrelated donors (MUD), anti-thymocyte globulin (ATG), and mycophenolate mofetil (MMF).
Analyzed the association of tacrolimus exposure with key outcomes.
Considered patient and donor factors in the evaluation.
Early tacrolimus exposure did not independently predict relapse, non-relapse mortality (NRM), event-free survival (EFS), or overall survival (OS).
Patient and donor characteristics were more influential on outcomes than tacrolimus exposure levels.
AUC-targeting for tacrolimus was argued against due to lack of observed benefits; risk-adapted tapering and residual disease-guided strategies may improve outcomes.

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Implication

This analysis finds that early tacrolimus levels do not predict transplantation outcomes, suggesting alternative strategies may be more effective.

Abstract

Within a homogeneous MUD/ATG/MMF setting, early tacrolimus exposure did not independently predict relapse, NRM, EFS, or OS. Patient and donor factors outweighed tacrolimus AUC. Findings argue against AUC-targeting to improve outcomes; risk-adapted tapering and MRD-guided interventions may offer greater leverage.

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Jäger et al. (2026) studied this question.

synapsesocial.com/papers/69d9e62078050d08c1b76606 https://doi.org/10.1007/s00277-026-06988-0

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Impact of early tacrolimus exposure on outcomes after allogeneic hematopoietic cell transplantation for acute myeloid leukemia and myelodysplastic syndromes

Key Points

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Impact of early tacrolimus exposure on outcomes after allogeneic hematopoietic cell transplantation for acute myeloid leukemia and myelodysplastic syndromes

Key Points

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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