{
  "abstract": "Allogeneic cord blood transplantation (CBT) is a curative option for adults with high-risk acute myeloid leukemia, but outcomes depend on conditioning intensity and graft-versus-host disease (GVHD) prophylaxis. We analyzed 1311 adults undergoing first single-unit CBT with six protocol-defined myeloablative or reduced-intensity regimens and uniform calcineurin inhibitor plus short-course methotrexate (MTX) at high, standard, or low doses. Neutrophil engraftment was rapid (median 20 days) and similar across MTX dose categories. The 2-year overall and disease-free survival rates were 48.5% and 44.1%, and 1-year transplant-related mortality was 30.7%. Low-dose MTX was independently associated with more chronic GVHD and inferior chronic GVHD-free/relapse-free survival without reducing relapse in chemotherapy-based myeloablative and fludarabine-based reduced-intensity regimens. Regarding total-body-irradiation–based myeloablative regimens, more intensive MTX exposure was associated with lower rates of grade II–IV acute GVHD and improved GVHD-free/relapse-free survival compared with low-dose MTX. For chemotherapy-based myeloablative and fludarabine-based reduced-intensity regimens, standard-dose MTX generally provided the most favorable balance between GVHD control and survival. These nationwide data suggest that MTX exposure should be tailored to the conditioning backbone rather than uniformly reduced, and provide pragmatic, regimen-specific benchmarks to individualize GVHD prophylaxis and guide future prospective and international comparative studies of CBT for high-risk acute myeloid leukemia.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Hematology, St. Mary’s Hospital",
    "Department of Hematology and Oncology, Nagoya City University East Medical Center",
    "Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital",
    "Department of Hematology and Oncology, Tokai University School of Medicine",
    "Department of Hematology, Kanagawa Cancer Center",
    "Department of Hematology, Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospital",
    "Division of Hematology, Department of Medicine, Showa Medical University School of Medicine",
    "Department of Hematology, National Hospital Organization Sendai Medical Center",
    "Department of Hematology/Oncology, The Institute of Medical Science, The University of Tokyo",
    "Department of Hematology and Oncology, Anjo Kosei Hospital",
    "Department of Hematology, Hiroshima Red Cross Hospital & Atomic-bomb Survivors Hospital",
    "Department of Hematology, National Hospital Organization Kumamoto Medical Center",
    "Department of Hematology, Osaka International Cancer Institute",
    "Department of Hematology, Imamura General Hospital",
    "Department of Hematology, Tohoku University Hospital",
    "Division of Hematology and Oncology, Department of Medicine, Kurume University Hospital",
    "Division of Emerging Medicine for Integrated Therapeutics, Center for Molecular Medicine, Jichi Medical University",
    "Japanese Red Cross Blood Service Headquarters",
    "Department of Hematology, Graduate School of Medicine, Kyoto University",
    "Department of Registry Science for Transplant and Cellular Therapy, Aichi Medical University School of Medicine"
  ],
  "article_type": null,
  "arxiv": null,
  "author_total": 22,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Satoshi Yamasaki"
    },
    {
      "affs": [
        1
      ],
      "name": "Masamitsu Yanada"
    },
    {
      "affs": [
        2
      ],
      "name": "Tomomi Toubai"
    },
    {
      "affs": [
        3
      ],
      "name": "Kaito Harada"
    },
    {
      "affs": [
        4
      ],
      "name": "Masatsugu Tanaka"
    },
    {
      "affs": [
        3
      ],
      "name": "Makoto Onizuka"
    },
    {
      "affs": [
        5
      ],
      "name": "Tetsuya Nishida"
    },
    {
      "affs": [
        6
      ],
      "name": "Norimichi Hattori"
    },
    {
      "affs": [
        7
      ],
      "name": "Toru Izumi"
    },
    {
      "affs": [
        8
      ],
      "name": "Satoshi Takahashi"
    },
    {
      "affs": [
        9
      ],
      "name": "Masashi Sawa"
    },
    {
      "affs": [
        10
      ],
      "name": "Yuta Katayama"
    },
    {
      "affs": [
        11
      ],
      "name": "Toshiro Kawakita"
    },
    {
      "affs": [
        12
      ],
      "name": "Jun Ishikawa"
    },
    {
      "affs": [
        13
      ],
      "name": "Masahito Tokunaga"
    },
    {
      "affs": [
        14
      ],
      "name": "Koichi Onodera"
    },
    {
      "affs": [
        15
      ],
      "name": "Koji Nagafuji"
    },
    {
      "affs": [
        16
      ],
      "name": "Hideki Nakasone"
    },
    {
      "affs": [
        17
      ],
      "name": "Fumihiko Ishimaru"
    },
    {
      "affs": [
        18
      ],
      "name": "Junya Kanda"
    },
    {
      "affs": [
        19
      ],
      "name": "Yoshiko Atsuta"
    },
    {
      "affs": [
        8
      ],
      "name": "Takaaki Konuma"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/a474jrxp7sxqm.bib",
  "cited_by": 0,
  "doi": "10.1038/s41598-026-63050-9",
  "fulltext_url": "https://doi.org/10.1038/s41598-026-63050-9",
  "id": "a474jrxp7sxqm",
  "issns": [
    "2045-2322"
  ],
  "landing_url": "https://doi.org/10.1038/s41598-026-63050-9",
  "language": "en",
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "journal",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "lcc",
      "Q"
    ],
    [
      "lcc",
      "R"
    ],
    [
      "openalex",
      "2720|Hematopoietic Stem Cell Transplantation"
    ]
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  "openalex": "W7169756015",
  "pdf_url": "https://www.nature.com/articles/s41598-026-63050-9_reference.pdf",
  "pmcid": null,
  "pmid": null,
  "published": "2026-07-01",
  "publisher": "Nature Portfolio",
  "ris": "https://research.draconitic.com/paper/a474jrxp7sxqm.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T13:45:48Z",
      "native_id": "bafa4e7b0d78476bbee21eeea2f8da88",
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      "url": "https://doi.org/10.1038/s41598-026-63050-9"
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  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2720|Hematopoietic Stem Cell Transplantation",
      "subfield": "general"
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  ],
  "title": "Conditioning-adapted methotrexate in cord blood transplantation for high-risk acute myeloid leukemia: a nationwide Japanese cohort analysis",
  "title_text": "Conditioning-adapted methotrexate in cord blood transplantation for high-risk acute myeloid leukemia: a nationwide Japanese cohort analysis",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T13:45:48Z",
  "url": "https://research.draconitic.com/paper/a474jrxp7sxqm",
  "venue": "Scientific Reports",
  "versions": []
}