A Novel GVHD-Prophylaxis with Low-Dose Alemtuzumab in Allogeneic Sibling or Unrelated Donor Hematopoetic Cell Transplantation: The Feasibility of Deescalation
A Novel GVHD-Prophylaxis with Low-Dose Alemtuzumab in Allogeneic Sibling or Unrelated Donor Hematopoetic Cell Transplantation: The Feasibility of Deescalation
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DOI：
10.1016/j.bbmt.2009.08.002
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发表时间：
2009-12-01
影响因子：
4.3
通讯作者：
Finke, Juergen
中科院分区：
文献类型：
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作者：
Bertz, Hartmut;Spyridonidis, Alexandros;Finke, Juergen
在维持移植物抗白血病（GVL）/淋巴瘤效应和预防严重感染性疾病的同时，预防急性移植物抗宿主病（aGVHD）仍然是异基因造血细胞移植（allo-HCT）的主要挑战。为了评估这一点，我们在一项观察性队列研究中检查了在基于氟达拉滨（Flu）的降低强度预处理（RIC）后，将阿仑单抗（MabCampath（TM））联合环孢素（CsA）作为唯一GVHD预防措施的可行性。我们纳入了127例连续患者（中位年龄63岁），他们在首次移植后接受了非相关（UD; n=69）或相关供体（SIB; n=58），大多数表现为晚期疾病。前30例患者在第-2天和第-1天接受20 mg/天（40 mg），随后48例患者在第-2天和第-1天接受10 mg/天（20 mg），最后49例患者在第-1天接受10 mg（10 mg）Alemtuzumab静脉（i. v.）移植前。我们观察到40 mg、20 mg或10 mg剂量组在III-IV级aGVHD累积发生率7%方面无统计学差异。（置信区间[CI] 95%; 1-51）、12%（1-40）、6%（1-40）、广泛慢性GVHD（cGVHD）24.4% Ⅱ ~ Ⅳ级aGVHD分别为7%（0 ~ 51.5）、29%（11.9 -49.1）、21%（15.3-43.1）。20 mg组和40 mg组之间的aGVHD II-IV级差异有统计学意义（P
Prophylaxis of acute graft-versus-host disease (aGVHD), while maintaining the graft-versus-leukemia (GVL)/lymphoma effect and preventing severe infectious diseases, remains the main challenge in allogeneic hematopoetic cell transplantation (allo-HCT). To evaluate this, we examined the feasibility of deescalating the dose of alemtuzumab (MabCampath (TM)) in combination with cyclosporine (CsA) as the sole GVHD-prophylaxis in patients after fludarabine (Flu)-based reduced-intensity conditioning (RIC) in an observational cohort study. We included 127 consecutive patients (median age 63 years) with an unrelated (UD; n=69) or related donor (SIB; n=58) after their first transplantation, mostly presenting with advanced disease. The first 30 patients received 20 mg/day on day -2 and -1 (40 mg), the following 48 patients 10 mg/day on day -2 and -1 (20 mg), and the last 49 patients 10 mg on day -1 (10 mg) alemtuzumab intravenous (i.v.) prior to transplant. We observed no statistical differences comparing the 40 mg, 20 mg, or 10 mg dose groups, in terms of cumulative incidences of aGVHD grade III-IV 7% (confidence interval [CI] 95%; 1-51), 12% (1-40), 6% (1-40), extensive chronic GVHD (cGVHD) 24.4% (3.3-55.8), 17% (2.5-42), and 14.2% (1.5-41.5) and of aGVHD grade II-IV 7% (0-51.5), 29% (11.9-49.1), 21% (15.3-43.1), respectively. The difference between the 20-mg and 40-mg groups was significant for aGVHD grade II-IV(P