Tailoring the GVHD prophylaxis regimen according to transplantation associated toxicities—Substituting the 3rd dose of methotrexate to mycophenolate mofetil

•Patients with post-transplant toxicities given MMF had a higher incidence of grade 2–4 acute GVHD.•Patients with post-transplant toxicities given MMF had similar incidence of grade 3-4 acute GVHD.•Incidences of chronic GVHD, relapse rate, NRM and OS were similar in both group.

We hypothesized that in patients with early post allogeneic transplantation toxicities, the omission of the 3rd dose of methotrexate with concomitant starting of MMF would favorably affect complications. We found a higher incidence of grade 2–4 acute GVHD in patients given two doses methotrexate and MMF (n = 31) compared to those given three courses of methotrexate (n = 70) (p = .004), while grade 3-4 was similar. Other transplantation outcomes, including overall regimen-related-toxicity, were comparable. We conclude that tailoring the GVHD prophylaxis regimen may decrease the early post transplantation complications, however this come at the extent of a higher incidence of non-severe acute GVHD.