CYCLOSPORINE MONITORING - IMPROVES GRAFT-VERSUS-HOST DISEASE PROPHYLAXIS AFTER BONE-MARROW TRANSPLANTATION
CYCLOSPORINE MONITORING - IMPROVES GRAFT-VERSUS-HOST DISEASE PROPHYLAXIS AFTER BONE-MARROW TRANSPLANTATION
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DOI：
10.1177/106002809402800315
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发表时间：
1994-03-01
影响因子：
2.9
通讯作者：
KAIZER, H
中科院分区：
文献类型：
--
作者：
GHALIE, R;FITZSIMMONS, WE;KAIZER, H
目的：本研究的主要目的是确定是否存在的关系，通过HPLC测定的环孢素谷浓度和发展的急性移植物抗宿主病（GVHD）异基因骨髓transplantation.DESIGN：一个回顾性分析59个连续的人类白细胞抗原匹配的骨髓移植。患者接受统一的GVHD预防与环孢素和甲氨蝶呤。全血环孢素谷浓度测定至少每周两次住院期间和每周出院后。设置：一个专门的骨髓移植单位在学术center.Main结果MEASURES：环孢素浓度的平均值进行了评估，为每个病人在移植后的第一个50天内每周的基础上。这些手段之间进行了比较，患者发展2-4级急性GVHD和患者没有显着的GVHD.RESULTS：18例患者发生急性GVHD的中位数为25天后骨髓移植（范围10-50）。GVHD的发生与患者年龄、诊断、供体年龄、供体性别、供体-受体性别不匹配和中性粒细胞植入时间（>1000 x 10（6）cells/L）无关。尽管发生急性GVHD的患者的平均每周环孢素浓度始终较低，但与GVHD患者相比，该值的差异无统计学意义。中性粒细胞植入时平均每周环孢素浓度与GVHD的发生有统计学相关性。GVHD患者的平均+/- SD浓度为174 +/- 69 ng/mL，显著低于无GVHD患者的254 +/- 114 ng/mL。此外，在平均浓度为100 mg/kg的患者中，
OBJECTIVE: The principal objective of this study was to determine whether a relationship exists between trough cyclosporine concentrations measured by HPLC and the development of acute graft-versus-host disease (GVHD) after allogeneic bone marrow transplantation.DESIGN: A retrospective analysis of 59 consecutive human Leukocyte antigen-matched bone marrow transplants. Patients received uniform GVHD prophylaxis with cyclosporine and methotrexate. Whole blood trough cyclosporine concentrations were measured at least twice weekly during hospitalization and weekly after discharge.SETTING: A dedicated bone marrow transplant unit in an academic center.MAIN OUTCOME MEASURES: The means of cyclosporine concentrations were assessed for each patient on a weekly basis during the first 50 days after transplant. These means were compared between patients developing grade 2-4 acute GVHD and patients without significant GVHD.RESULTS: Eighteen patients developed acute GVHD at a median of 25 days after bone marrow transplant (range 10-50). There was no correlation between the development of GVHD and patient age, diagnosis, donor age, donor gender, donor-recipient gender mismatch, and time to neutrophil engraftment (>1000 x 10(6) cells/L). Although mean weekly cyclosporine concentrations were consistently lower in patients developing acute GVHD, the difference in values compared with those of patients with GVHD was not statistically significant. Mean weekly cyclosporine concentrations at the time of neutrophil engraftment were statistically associated with the development of GVHD. Patients with GVHD had mean +/- SD concentrations of 174 +/- 69 ng/mL, significantly lower than 254 +/- 114 ng/mL in patients without GVHD. Furthermore, the rate of GVHD was 82 percent in patients with mean concentrations