Short-term methotrexate could reduce early immune reactions and improve outcomes in umbilical cord blood transplantation for adults
Short-term methotrexate could reduce early immune reactions and improve outcomes in umbilical cord blood transplantation for adults
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DOI：
10.1038/sj.bmt.1705539
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发表时间：
2007-01-01
影响因子：
4.8
通讯作者：
Morishita, Y.
中科院分区：
文献类型：
--
作者：
Narimatsu, H.;Terakura, S.;Morishita, Y.
移植后免疫紊乱是成人脐带血移植(CBT)中存在的问题，最佳的预防措施尚未确定。我们调查了短期甲氨蝶呤(MTX)强化预防移植物抗宿主病(GVHD)是否对CBT的预后有影响。移植后免疫反应按时间进程分为植入前免疫反应(PIR)、植入综合征(ES)和急性移植物抗宿主病(GVHD)。2001年3月至2005年11月，共有77名患者在8个移植中心接受了CBT。中位年龄48岁(范围18-69岁)。准备方案包括清髓方案(n=31)或减量方案(n=46)。急性移植物抗宿主病包括环孢素23例，他克莫司12例，环孢素+甲氨蝶呤17例，他克莫司+短期甲氨蝶呤23例，环孢素+甲基强的松龙2例。PIR、ES和II-IV级移植物抗宿主病的累积发生率分别为36%、12%和23%。多因素分析显示，短期MTX对CBT后免疫反应有显著的有利作用(危险比0.55；95%可信区间0.31~0.98；P=0.04)。有或无短期甲氨蝶呤的患者180d总生存率分别为59%(95%可信区间，42-73%)和16%(95%可信区间，6.6-30%)(P=0.0001)。短期应用MTX可为CBT提供一种减少免疫反应、改善预后的最佳方案。
Post transplant immune disorders are problematic in cord blood transplantation (CBT) for adult patients, and optimal prophylaxis has not been established. We investigated whether intensive graft-versus-host disease (GVHD) prophylaxis using short-term methotrexate (MTX) has a prognostic impact on CBT. Post-CBT immune reactions were classified according to time course as pre-engraftment immune reaction (PIR), engraftment syndrome (ES) or acute GVHD. Between March 2001 and November 2005, a total of 77 patients underwent CBT at eight transplantation centers. Median age was 48 years ( range, 18 - 69 years). Preparative regimens comprised myeloablative (n = 31) or reduced-intensity ( n 46). Acute GVHD prophylaxis included cyclosporine alone ( n 23), tacrolimus alone ( n 12), cyclosporine plus MTX ( n 17), tacrolimus plus short-term MTX ( n 23) or cyclosporine plus methylprednisolone ( n 2). Cumulative incidences of PIR, ES and grade II - IV GVHD were 36, 12 and 23%, respectively. Short-term MTX exerted significant favorable effects on post-CBT immune reactions ( hazard ratio, 0.55; 95% confidence interval ( 95% CI), 0.31 - 0.98; P = 0.04) in multivariate analysis. Overall survival rates for patients with and without short-term MTX at day 180 were 59% ( 95% CI, 42 - 73%) and 16% ( 95% CI, 6.6 - 30%) ( P = 0.0001), respectively. Short-term MTX could offer one optimal regimen to reduce immune reactions and improve outcomes in CBT.