Tacrolimus and mycophenolate mofetil after nonmyeloablative matched-sibling donor allogeneic stem-cell transplantations conditioned with fludarabine and low-dose total body irradiation
Tacrolimus and mycophenolate mofetil after nonmyeloablative matched-sibling donor allogeneic stem-cell transplantations conditioned with fludarabine and low-dose total body irradiation
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DOI：
10.1016/j.bbmt.2005.10.012
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发表时间：
2006-02-01
影响因子：
4.3
通讯作者：
McSweeney, PA
中科院分区：
文献类型：
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作者：
Nieto, Y;Patton, N;McSweeney, PA
我们评估了他克莫司/吗替麦考酚酯 (MMF) 在匹配的同胞供体 (MSD) 进行非清髓性干细胞移植 (NST) 后预防移植物抗宿主病 (GVHD) 的作用。 32 名患有晚期血液恶性肿瘤的患者（中位年龄 57 岁）不适合常规清髓移植，接受氟达拉滨（30 mg/m(2)，第 -4 天至第 -2 天）、全身照射 (TBI)（200 cGy，第 0 天）、输注供者外周血祖细胞（第 0 天）、口服他克莫司 0.06 mg/kg，每天两次（从第 3 天开始），每天两次口服 MMF 15 mg/kg（第 0-+27 天）。对于惰性恶性肿瘤患者（n = 25），他克莫司的剂量从+100天逐渐减少到+180天；对于侵袭性肿瘤患者（n = 7），他克莫司从+35天到+56天逐渐减少。治疗方案毒性和骨髓抑制都很轻微，使得 75% 的患者完全可以在门诊接受移植。一名患者 (3%) 经历了非致命性移植物排斥反应。 II-IV级和III-IV级急性GVHD发生率分别为15.6%和3%lv。急性 GVHD 在中位第 +78 天（范围，第 +31-+84 天）被诊断出来。在 24 名可评估患者中，有 10 名 (41.6%) 观察到广泛的慢性 GVHD，中位发病时间为第 +198 天（范围，第 +128-+277 天），要么是自发的（n = 5），要么是在肿瘤进展后引起的（n = 5）。 5 名患者因急性 GVHD 相关多器官衰竭 (MOF) (n = 3) 或感染并发症 (n = 2) 出现移植相关死亡率 (TRM) (15.6%)。中位随访 19 个月（范围 2-41 个月）时，总生存率、无进展生存率和无病生存率分别为 62.5%、50% 和 40%。总之，MSD NST 后使用他克莫司/MMF 与令人鼓舞的 GVHD 控制率相关。 (C) 2006 年美国血液和骨髓移植协会。
We evaluated tacrolimus/mycophenolate mofetil (MMF) for graft-versus-host disease (GVHD) prophylaxis after a nonmyeloablative stem cell transplantation (NST) from a matched sibling donor (MSD). Thirty-two patients (median age, 57 years) with advanced hematologic malignancies, who were poor candidates for a conventional myeloablative transplantation, received fludarabine (30 mg/m(2), day -4 to day -2), total-body irradiation (TBI) (200 cGy, day 0), infusion of donor peripheral blood progenitor cells (day 0), oral tacrolimus 0.06 mg/kg twice daily (from day 3), and oral MMF at 15 mg/kg twice daily (days 0-+27). Tacrolimus was tapered from day +100 to day +180 in those patients with indolent malignancies (n = 25), and from day +35 to day +56 in those with aggressive tumors (n = 7). Regimen toxicities and myelosuppression were mild, allowing 75% of patients to have entirely outpatient transplantations. One patient (3%) experienced a nonfatal graft rejection. Rates of grades II-IV and III-IV acute GVHD were 15.6% and 3 %, respectivelv. Acute GVHD was diagnosed at median day +78 (range, days +31-+84). Extensive chronic GVHD was observed in 10 of 24 evaluable patients (41.6%) at a median onset of day +198 (range, days +128-+277), either spontaneously (n 5) or elicited after tumor progression (n = 5). Five patients experienced transplantation-related mortality (TRM) (15.6%) from either acute GVHD-related multiorgan failure (MOF) (n = 3) or infectious complications (n = 2). At median follow-up of 19 months (range, 2-41 months), the overall survival, progression-free survival, and disease-free survival rates are 62.5%, 50%, and 40%, respectively. In conclusion, the use of tacrolimus/ MMF after MSD NST is associated with encouraging rates of GVHD control. (C) 2006 American Society for Blood and Marrow Transplantation.