Early immune reaction after reduced-intensity cord-blood transplantation for adult patients
Early immune reaction after reduced-intensity cord-blood transplantation for adult patients
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DOI：
10.1097/01.tp.0000163289.20406.86
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发表时间：
2005-07-15
期刊：
影响因子：
6.2
通讯作者：
Taniguchi, S
中科院分区：
文献类型：
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作者：
Kishi, Y;Kami, M;Taniguchi, S
背景资料。目的探讨减强度脐血移植(RI-CBT)后的免疫反应。我们回顾了57例成年RI-CBT受者的医疗记录。制备方案包括氟达拉滨、全身照射、马法兰(n=51)或白头翁(n=6)。移植物抗宿主病(GvHD)的预防是环孢素。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)和移植物抗宿主病(GvHD)。45名患者植入成功的中位数为19天。PIR的特点是高烧和体重增加，在45名可评估的患者中，35名患者的中位植入时间为9天，其中3名未植入。12例PIR自行消退，其余23例需要糖皮质激素治疗。ES和I~IV级急性GvHD分别为36例和29例。10例GVHD与既往PIR或ES不能区分。32例无复发死亡原因包括移植物抗宿主病(5例)和FIR(1例)。PIR患者和非PIR患者的复发和非复发死亡率无显著差异(分别为18%和5%，60%和65%)。RI-CBT后的免疫反应可分为三种不同的亚型。
Background. To investigate immune reactions after reduced-intensity cord-blood transplantation (RI-CBT).Materials and Methods. We reviewed medical records of 57 adult RI-CBT recipients. Preparative regimen comprised fludarabine, total-body irradiation, and either melphalan (n=51) or busulfan (n=6). Graft-versus-host disease (GvHD) prophylaxis was cyclosporine. PostRI-CBT immune reactions were classified according to time course: pre-engraftment immune reactions (PIR), engraftment syndrome (ES), and GvHD.Results. Forty-five patients achieved engraftment at a median of day 19. PIR was characterized by high-grade fever and weight gain and developed on a median of day 9 in 35 of the 45 evaluable patients, including 3 who did not achieve engraftment. PIR subsided spontaneously in 12 patients, whereas corticosteroids were required in the other 23. ES and grade I to IV acute GvHD developed in 36 and 29 patients, respectively. GvHD could not be distinguished from preceding PIR or ES in 10 patients. Causes of the 32 nonrelapse mortalities included GvHD (n=5) and FIR (n=1). There were no significant differences in relapse and nonrelapse deaths between patients with PIR and those without it (18% vs. 5%, and 60% vs. 65%, respectively).Conclusions. Immune reactions after RI-CBT can be categorized into three distinct subtypes.