{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,27]],"date-time":"2026-05-27T14:07:27Z","timestamp":1779890847871,"version":"3.53.1"},"reference-count":35,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2025,9,2]],"date-time":"2025-09-02T00:00:00Z","timestamp":1756771200000},"content-version":"vor","delay-in-days":1,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2025,9,1]],"date-time":"2025-09-01T00:00:00Z","timestamp":1756684800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Transplantation"],"published-print":{"date-parts":[[2025,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Graft\u2010versus\u2010host disease (GvHD) remains a major barrier to long\u2010term survival after allogeneic hematopoietic stem cell transplantation (allo\u2010HSCT). Although calcineurin inhibitors (CNIs) are the cornerstone of GvHD prophylaxis, some patients cannot tolerate them, creating a critical need for alternative strategies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To evaluate the efficacy and safety of sirolimus plus low\u2010exposure CNIs as an alternative GvHD prophylaxis in CNI\u2010intolerant recipients undergoing allo\u2010HSCT.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We retrospectively analyzed 16 allo\u2010HSCT recipients who received alternative GvHD prophylaxis due to CNI intolerance, evaluating GvHD incidence, survival and relapse outcomes, infectious complications, and immune reconstitution.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The median time to regimen initiation was 27.5\u00a0days (range, \u22122 to 114\u00a0days), and the median treatment duration was 53\u00a0days (range, 14\u2013319\u00a0days). Only one patient (6.3%) experienced grade 2 acute GvHD, and none developed grade 3\u20134 acute GvHD. No cases of chronic GvHD were observed in the 15 evaluable patients. Over a median follow\u2010up of 271\u00a0days (range, 58\u2013505\u00a0days), one non\u2010relapse mortality and three relapses (18.7%) occurred, with no relapse\u2010related deaths. The alternative regimen was well\u2010tolerated with manageable infections and, importantly, did not impair early T, B, or NK cell reconstitution.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>For allo\u2010HSCT recipients with CNI intolerance, this study provides the first evaluation of sirolimus combined with low\u2010exposure CNIs as a GvHD prophylaxis. Our findings suggest this regimen is a promising and feasible alternative, although validation in larger, prospective studies is warranted.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/ctr.70306","type":"journal-article","created":{"date-parts":[[2025,9,2]],"date-time":"2025-09-02T08:50:29Z","timestamp":1756803029000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Sirolimus Plus Low\u2010Exposure Calcineurin Inhibitors as an Alternative Graft\u2010Versus\u2010Host Disease Prophylaxis in Calcineurin Inhibitor\u2010Intolerant Recipients: A Retrospective Study"],"prefix":"10.1111","volume":"39","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-5992-4926","authenticated-orcid":false,"given":"Yanfei","family":"Lu","sequence":"first","affiliation":[{"name":"Department of Hematology The First Affiliated Hospital of Guangxi Medical University  Nanning Guangxi China"},{"name":"Department of Oncology The 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