Tacrolimus/Methotrexate versus cyclosporine/methotrexate as graft-versus-host disease prophylaxis in patients with severe aplastic anemia who received bone marrow transplantation from unrelated donors: results of matched pair analysis.
Tacrolimus/Methotrexate versus cyclosporine/methotrexate as graft-versus-host disease prophylaxis in patients with severe aplastic anemia who received bone marrow transplantation from unrelated donors: results of matched pair analysis.
复制标题
DOI：
10.1016/j.bbmt.2009.08.012
复制
发表时间：
2009-12
期刊：
影响因子：
--
通讯作者：
H. Yagasaki;S. Kojima;H. Yabe;Koji Kato;H. Kigasawa;H. Sakamaki;M. Tsuchida;S. Kato;Takakaza Kawase;H. Muramatsu;Y. Morishima;Y. Kodera
中科院分区：
文献类型：
--
作者：
H. Yagasaki;S. Kojima;H. Yabe;Koji Kato;H. Kigasawa;H. Sakamaki;M. Tsuchida;S. Kato;Takakaza Kawase;H. Muramatsu;Y. Morishima;Y. Kodera
他克莫司(FK)和环孢素A(CsA)已被证明在预防移植物抗宿主病(GVHD)方面有效。然而，目前还没有关于FK/MTX和CsA/MTX在接受非亲缘供者骨髓移植(U-BMT)的重型再生障碍性贫血(SAA)患者中的疗效的比较研究。我们使用配对分析比较了通过日本骨髓捐献者计划接受U-BMT的SAA患者的FK/MTX和CsA/MTX。47对配对可以在受者年龄和调理方案上完全匹配。FK组45例植入成功，CsA组42例植入成功。FK组发生II-IV级急性移植物抗宿主病(AGVHD)的概率为28.9%，CsA组为32.6%(P=.558)。慢性移植物抗宿主病(CGVHD)的发生率在FK组为13.3%，在CsA组为36.0%(P=.104)。5年生存率FK组为82.8%，CsA组为49.5%(P=0.012)。研究表明，FK/MTX在总存活率(OS)方面优于CsA/MTX，因为移植相关死亡的发生率较低。有必要进行前瞻性随机研究，比较FK/MTX和CsA/MTX。
Tacrolimus (FK) and cyclosporine (CSA) have been shown to be effective in the prophylaxis of graft-versus-host disease (GVHD). However, no comparative studies have yet been conducted to examine the efficacy of FK/methotrexate (MTX) and CSA/MTX in patients with severe aplastic anemia (SAA) given unrelated donor bone marrow transplantation (U-BMT). We used matched-pair analysis to compare FK/MTX with CSA/MTX in patients with SAA who received U-BMT through the Japan Marrow Donor Program. Forty-seven pairs could be matched exactly for recipient age and conditioning regimens. Forty-five patients achieved engraftment in the FK group and 42 patients in the CSA group. The probability of grade II-IV acute GVHD (aGVHD) was 28.9% in the FK group and 32.6% in the CSA group (P=.558). The probability of chronic GVHD (cGVHD) was 13.3% in the FK group and 36.0% in the CSA group (P=.104). The 5-year survival rate was 82.8% in the FK group and 49.5% in the CSA group (P=.012). The study shows the superiority of FK/MTX over CSA/MTX in overall survival (OS) because of the lower incidence of transplantation-related deaths. A prospective randomized study comparing FK/MTX and CSA/MTX is warranted.