Comparison of cyclosporine and tacrolimus combined with mycophenolate mofetil in prophylaxis for graft-versus-host disease after reduced-intensity umbilical cord blood transplantation
Comparison of cyclosporine and tacrolimus combined with mycophenolate mofetil in prophylaxis for graft-versus-host disease after reduced-intensity umbilical cord blood transplantation
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DOI：
10.1007/s12185-016-2093-0
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发表时间：
2017-01-01
影响因子：
2.1
通讯作者：
Akashi, Koichi
中科院分区：
文献类型：
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作者：
Miyamoto, Toshihiro;Takashima, Shuichiro;Akashi, Koichi
采用降低强度预处理方案的脐带血移植（RIC-UCBT）越来越多地用于具有合并器官功能且缺乏人类白细胞抗原相同供体的患者。我们比较了 35 名患者在 RIC-UCBT 后接受吗替麦考酚酯加环孢素 (MMF/CSP，n = 17) 或 MMF 加他克莫司 (MMF/TAC，n = 18) 预防移植物抗宿主病 (GVHD) 的结果。 MMF/CSP 和 MMF/TAC 组中性粒细胞植入的累积发生率分别为 94% 和 89%（p = 0.34）。 MMF/CSP (41%) 和 MMF/TAC (39%, p = 1.00) 组之间植入前免疫反应的发生率没有差异；然而，MMF/TAC 组患者的 II-IV 级急性 GVHD 发生率往往低于 MMF/CSP 组患者（28% vs 53%，p = 0.11）。 MMF/CSP 和 MMF/TAC 组的 1 年总生存率 (OS) 分别为 43% 和 60%（p = 0.39）。两组之间的无进展生存期、非复发死亡率和复发率相当（p 分别为 0.76、0.59 和 0.88）。在多变量分析中，MMF/TAC GVHD 预防与 OS 改善密切相关，但与植入和急性 GVHD 的发生率无关。这些结果表明，使用 MMF/TAC 进行更强化的 GVHD 预防可减少急性 GVHD，而不影响其他临床结果，从而改善 RIC-UCBT 后的 OS。
Umbilical cord blood transplantation with a reduced-intensity conditioning regimen (RIC-UCBT) is used increasingly in patients who have comorbid organ functions and lack human leukocyte antigen-identical donors. We compared the outcomes in 35 patients who received mycophenolate mofetil plus cyclosporine (MMF/CSP, n = 17) or MMF plus tacrolimus (MMF/TAC, n = 18) for graft-versus-host disease (GVHD) prophylaxis after RIC-UCBT. Cumulative incidence of neutrophil engraftment was 94 and 89 % in MMF/CSP and MMF/TAC groups, respectively (p = 0.34). The incidence of pre-engraftment immune reaction did not differ between the MMF/CSP (41 %) and MMF/TAC (39 %, p = 1.00) groups; however, patients in the MMF/TAC group tended to have a lower incidence of grade II-IV acute GVHD than those in MMF/CSP group (28 vs 53 %, p = 0.11). Overall survival (OS) at 1 year was 43 and 60 % in MMF/CSP and MMF/TAC groups, respectively (p = 0.39). Progression-free survival, non-relapse mortality, and relapse rate were comparable between the two groups (p = 0.76, 0.59, and 0.88, respectively). In multivariate analyses, MMF/TAC GVHD prophylaxis was closely associated with improved OS, but not with incidence of engraftment and acute GVHD. These results suggest that more intensive GVHD prophylaxis with MMF/TAC decreased acute GVHD without affecting other clinical outcomes, resulting in improved OS after RIC-UCBT.