Cyclosporine is required to prevent severe acute GVHD following T-cell-depleted peripheral blood stem cell transplantation.
Cyclosporine is required to prevent severe acute GVHD following T-cell-depleted peripheral blood stem cell transplantation.
复制标题
需要环孢素来预防 T 细胞耗尽的外周血干细胞移植后的严重急性 GVHD。
DOI：
10.1038/sj.bmt.1703928
复制
发表时间：
2003
影响因子：
4.8
通讯作者：
Barrett,AJ
中科院分区：
文献类型：
--
作者：
Solomon,SR;Nakamura,R;Read,EJ;Leitman,SF;Carter,C;Childs,R;Dunbar,CE;Young,NS;Barrett,AJ
减少免疫抑制可以改善异基因干细胞移植后的免疫恢复，并增加移植物抗白血病效应。此外，广泛的T细胞耗竭后移植后免疫抑制的要求仍不清楚。因此，我们评估了环孢素（CSA）在HLA-相同的T-细胞耗尽的外周血干细胞移植（PBSCT），然后在第+45天和+100天进行供体淋巴细胞输注（DLI）的受体中的作用。在第+45天之前，连续队列的患者接受递减量的CSA：标准剂量（SD）CSA、低剂量（LD）CSA或在第+45天之前不接受CSA。LD CSA预防急性移植物抗宿主病（GVHD）的效果与SD CSA相当。然而，在未接受CSA的患者中，中度至重度急性GVHD在第+45天DLI前显著更频繁（33.3% vs 12.7%，P= 0.036，包括仅有的4例III-IV级病例）。由于早期急性GVHD的发生率较高，“无CSA”组中更多的患者未能接受任何DLI（30.7% vs 7.1%，P= 0.01）。总体而言，急性GVHD的发生率没有差异，因为接受CSA的患者在DLI后发生更多GVHD。同样，在慢性GVHD、移植相关死亡率或存活率方面也没有发现显著差异。这些结果定义了CSA在PBSCT后低T细胞剂量下预防GVHD的作用。
Reduced immunosuppression may improve immune recovery and increase the graft-versus-leukemia effect after allogeneic stem cell transplantation. Furthermore, the requirement for post-transplant immunosuppression following extensive T-cell depletion remains unclear. We therefore evaluated the role of cyclosporine (CSA) in recipients of HLA-identical T-cell-depleted peripheral blood stem cell transplants (PBSCT), followed by donor lymphocyte infusions (DLIs) scheduled on days+ 45 and+ 100. Before day+ 45, successive cohorts of patients received decreasing amounts of CSA: standard-dose (SD) CSA, low-dose (LD) CSA, or no CSA until day+ 45. LD CSA was as effective as SD CSA in preventing acute graft-versus-host disease (GVHD). However, moderate-to-severe acute GVHD was significantly more frequent before the day+ 45 DLI in patients receiving no CSA (33.3 vs 12.7%, P= 0.036, including the only four grade III–IV cases). As a result of higher rates of early acute GVHD, more patients in the ‘no CSA’group failed to receive any DLI (30.7 vs 7.1%, P= 0.01). Overall, there was no difference in the incidence of acute GVHD, as patients receiving CSA developed more GVHD after DLI. Similarly, no significant differences were found in chronic GVHD, transplant-related mortality, or survival. These results define a role for CSA in preventing GVHD at low T-cell doses following PBSCT.