Extracorporeal photopheresis for the prevention of acute GVHD in patients undergoing standard myeloablative conditioning and allogeneic hematopoietic stem cell transplantation.
Extracorporeal photopheresis for the prevention of acute GVHD in patients undergoing standard myeloablative conditioning and allogeneic hematopoietic stem cell transplantation.
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DOI：
10.1038/bmt.2009.307
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发表时间：
2010-06
影响因子：
4.8
通讯作者：
Abhyankar S
中科院分区：
文献类型：
--
作者：
Shaughnessy PJ;Bolwell BJ;van Besien K;Mistrik M;Grigg A;Dodds A;Prince HM;Durrant S;Ilhan O;Parenti D;Gallo J;Foss F;Apperley J;Zhang MJ;Horowitz MM;Abhyankar S
移植物抗宿主病（GVHD）部分是由激活供体t细胞的宿主抗原呈递细胞（APCs）介导的。体外光合作用（Extracorporeal photopheresis， ECP）可以调节APC功能，使一些GVHD患者受益。我们报告了一项研究的结果，该研究使用ECP在标准的清骨髓预备方案之前进行，旨在预防GVHD。II-IV级aGVHD发生在30例hla匹配相关移植受者中的9例（30%）和31例hla匹配非相关或hla错配相关供者移植受者中的13例（42%）。移植后100天和1年的总生存率（OS）精算估计分别为89% （95% CI, 78%-94%）和77% （95% CI, 64%-86%）。ECP无意外不良反应。从国际血液和骨髓移植研究中心的数据库中确定了接受类似条件和GVHD预防方案但没有ECP的历史对照组，多因素分析表明，接受ECP的患者发生II-IV级aGVHD的风险较低（p=0.04）。ECP研究组1年调整OS为83%，历史对照组67%（相对危险度0.44,95% CI, 0.24-0.80） （p= 0.007）。这些初步数据可能表明，对于接受标准清髓性造血细胞移植的移植受者，ECP具有潜在的生存优势。
Graft-versus-host disease (GVHD) is partly mediated by host antigen presenting cells (APCs) that activate donor T-cells. Extracorporeal photopheresis (ECP) can modulate APC function and benefit some patients with GVHD. We report the results of a study using ECP administered prior to a standard myeloablative preparative regimen intended to prevent GVHD. Grade II-IV aGVHD developed in 9 (30%) of 30 recipients of HLA-matched related transplants and 13 (42%) of 31 recipients of HLA-matched unrelated or HLA-mismatched related donor transplants. Actuarial estimates of overall survival (OS) at day 100 and 1 year post transplant were 89% (95% CI, 78%-94%) and 77% (95% CI, 64%-86%), respectively. There were no unexpected adverse effects of ECP. Historical controls receiving similar conditioning and GVHD prophylaxis regimens but no ECP were identified from the database of the Center for International Blood and Marrow Transplant Research and multivariate analysis indicated a lower risk of grade II-IV aGVHD in patients receiving ECP (p=0.04). Adjusted OS at one year was 83% in the ECP study group and 67% in the historical control group (relative risk 0.44, 95% CI, 0.24-0.80) (p= 0.007). These preliminary data may indicate a potential survival advantage with ECP for transplant recipients undergoing standard myeloablative hematopoietic cell transplantation.
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