Cyclosporine/methotrexate versus tacrolimus/methotrexate with or without anti-thymocyte globulin as GVHD prophylaxis in adult patients with aplastic anemia
Cyclosporine/methotrexate versus tacrolimus/methotrexate with or without anti-thymocyte globulin as GVHD prophylaxis in adult patients with aplastic anemia
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环孢素/甲氨蝶呤与他克莫司/甲氨蝶呤联合或不联合抗胸腺细胞球蛋白作为成人再生障碍性贫血患者 GVHD 预防的比较
DOI：
10.1007/s00277-020-04290-1
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发表时间：
2020
影响因子：
3.5
通讯作者：
et al.
中科院分区：
文献类型：
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作者：
Onishi Yasushi;et al.
钙调磷酸酶抑制剂类型和抗胸腺细胞球蛋白（ATG）在预处理中对总生存期（OS）和无GVHD、无复发生存期（GRFS）的影响尚未详细分析再生障碍性贫血。我们在此检查了517例成人再生障碍性贫血患者，他们接受了来自HLA匹配的同胞供体（MSD，n= 255）和无关供体（UD，n= 262）的BMT，并接受了环孢素A（CSA）+甲氨蝶呤（MTX）（n= 258）和他克莫司（TAC）+ MTX（n= 259）的治疗。总共有330名患者在预处理中接受了ATG。CSA + MTX与TAC + MTX相比，对每种供体类型的急性和慢性GVHD、OS或GRFS没有显著影响。在预处理中使用ATG降低了MSD和UD队列中发生II-IV级急性GVHD的风险（HR分别为0.42，P = 0.014和0.3，P < 0.001）;然而，对GRFS的影响不同，即MSD受者GRFS更好（HR 0.56，P = 0.016），而UD受者没有（HR 1.1，P = 0.657）。总之，CSA + MTX和TAC + MTX与GVHD预防相似，无论供体类型如何，ATG在调节中增加MSD移植物的GRFS，但在UD移植物中不增加。
The impact of calcineurin inhibitor types and anti-thymocyte globulin (ATG) in conditioning on overall survival (OS) and GVHD-free, relapse-free survival (GRFS) has not yet been analyzed in detail for aplastic anemia. We herein examined 517 adult patients with aplastic anemia who underwent BMT from HLA-matched sibling donors (MSD,n= 255) and unrelated donors (UD,n= 262) and were treated with cyclosporine A (CSA) + methotrexate (MTX) (n= 258) and tacrolimus (TAC) + MTX (n= 259). In total, 330 patients received ATG in conditioning. CSA + MTX versus TAC + MTX did not have a significant impact on acute and chronic GVHD, OS, or GRFS in each donor type. The use of ATG in conditioning reduced the risk of grade II–IV acute GVHD in the MSD and UD cohorts (HR 0.42,P= 0.014, and HR 0.3,P< 0.001, respectively); however, a differential impact on GRFS was identified, namely, better GRFS in MSD recipients (HR 0.56,P= 0.016), but not in UD recipients (HR 1.1,P= 0.657). In conclusion, CSA + MTX and TAC + MTX were similar as GVHD prophylaxis regardless of the donor type, and ATG in conditioning increased GRFS in MSD transplants, but not in UD transplants.