Post-transplantation cyclophosphamide versus conventional graft-versus-host disease prophylaxis in mismatched unrelated donor haematopoietic cell transplantation.
Post-transplantation cyclophosphamide versus conventional graft-versus-host disease prophylaxis in mismatched unrelated donor haematopoietic cell transplantation.
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DOI：
10.1111/bjh.13977
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发表时间：
2016-05
影响因子：
6.5
通讯作者：
Ciurea SO
中科院分区：
文献类型：
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作者：
Mehta RS;Saliba RM;Chen J;Rondon G;Hammerstrom AE;Alousi A;Qazilbash M;Bashir Q;Ahmed S;Popat U;Hosing C;Khouri I;Shpall EJ;Champlin RE;Ciurea SO
移植后环磷酰胺(PTCy)是预防半相合造血细胞移植(HCT)后移植物抗宿主病(GVHD)的有效策略。我们确定了基于PTCy的预防人类白细胞抗原(HLA)不相合非血缘关系供者(MMUD)HCT的GVHD的有效性。我们分析了2009年至2013年间接受单抗原MMUD移植的113名患有高危血液系统恶性肿瘤的成人患者。其中41例患者接受PTCy、他克莫司和霉酚酸酯(MMF)预防GVHD，72例患者接受抗胸腺细胞球蛋白、他克莫司和甲氨蝶呤的常规预防。移植物来源主要是骨髓(83%的PTCy与63%的常规组)。第100天，II-IV级(37%对36%，P=0.8)和III-IV级(17%对12%，P=0.5)急性移植物抗宿主病的发生率相似。然而，PTCy组30天时II-IV级急性移植物抗宿主病的发生率显著低于对照组(0%比15%，P=0.01)。中性粒细胞和血小板的中位植入时间，PTCy组分别为18天和12天，P=0.001。移植物衰竭、慢性移植物抗宿主病、2年无复发死亡率、复发、无进展存活率或总存活率相似。我们的结果表明，PTCy、他克莫司和MMF预防移植物抗宿主病是安全的，在只有一种抗原-MMUD HCT的患者中，其效果与传统预防方法相似。
Post-transplantation cyclophosphamide (PTCy) is an effective strategy to prevent graft-versus-host disease (GVHD) after haploidentical haematopoietic cell transplantation (HCT). We determined the efficacy of PTCy-based GVHD prophylaxis in human leucocyte antigen (HLA)-mismatched unrelated donor (MMUD) HCT. We analysed 113 adult patients with high-risk haematological malignancies who underwent one-antigen MMUD transplantation between 2009 and 2013. Of these, 41 patients received PTCy, tacrolimus and mycophenolate mofetil (MMF) for GVHD prophylaxis; 72 patients received conventional prophylaxis with anti-thymocyte globulin, tacrolimus and methotrexate. Graft source was primarily bone marrow (83% PTCy vs. 63% conventional group). Incidence of grade II–IV (37% vs. 36%, P = 0.8) and grade III–IV (17% vs. 12%, P = 0.5) acute GVHD was similar at day 100. However, the incidence of grade II–IV acute GVHD by day 30 was significantly lower in the PTCy group (0% vs. 15%, P = 0.01). Median time to neutrophil (18 days vs. 12 days, P < 0.001) and platelet (25.5 days vs. 18 days, P = 0.05) engraftment was prolonged in PTCy group. Rates of graft failure, chronic GVHD, 2-year non-relapse mortality, relapse, progression-free survival or overall survival were similar. Our results demonstrate that PTCy, tacrolimus and MMF for GVHD prophylaxis is safe and produced similar results as conventional prophylaxis in patients with one antigen HLA-MMUD HCT.