Post-transplant cyclophosphamide for graft-versus-host disease prophylaxis in HLA matched sibling or matched unrelated donor transplant for patients with acute leukemia, on behalf of ALWP-EBMT.
Post-transplant cyclophosphamide for graft-versus-host disease prophylaxis in HLA matched sibling or matched unrelated donor transplant for patients with acute leukemia, on behalf of ALWP-EBMT.
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DOI：
10.1186/s13045-018-0586-4
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发表时间：
2018-03-15
影响因子：
28.5
通讯作者：
Nagler A
中科院分区：
文献类型：
--
作者：
Ruggeri A;Labopin M;Bacigalupo A;Afanasyev B;Cornelissen JJ;Elmaagacli A;Itälä-Remes M;Blaise D;Meijer E;Koc Y;Milpied N;Schouten HC;Kroeger N;Mohty M;Nagler A
使用移植后环磷酰胺(PT-Cy)预防来自匹配同胞供者(MSD)或无关供者(UD)的异基因干细胞移植(HSCT)的经验有限，结果存在争议。本研究的目的是评价PT-Cy在预防MSD和UD移植后移植物抗宿主病中的作用。我们分析了423例急性白血病患者接受PT-Cy单独或联合其他免疫抑制(IS)药物预防GVHD。其中PT-Cy组78例(第1组)，PT-Cy联合环孢素A(CsA)、甲氨蝶呤(MTX)或霉酚酸酯(MMF)2 0 4例(第2组)，PT-Cy联合CsA + MTX或CsA + MMF(第3组)141例。移植手术从2007年到2015年进行，平均随访时间为20个月。两年后三组的总生存概率(OS)分别为50%、52.2%和62.4%，p= 0.06。在多因素分析中，与单独使用PT-Cy相比，添加两种IS药物可降低广泛性移植物抗宿主病的风险(HR0.25，p= 0.02)。骨髓(BM)和抗胸腺细胞球蛋白的使用与广泛cGVHD的风险降低独立相关。无复发死亡率的预后因素是在PT-Cy基础上加用两种IS药物(HR0.35，p= 0.04)，急性髓细胞白血病的诊断，移植时的疾病状态，以及患者巨细胞病毒血清学。与OS增加相关的因素是联合使用PT-Cy和两种IS药物(HR0.49，p= 0.02)、急性髓细胞白血病和移植时的疾病状态。对于MSD和UD HSCT中GVHD的预防，在PT-Cy中加入IS药物可增强其效果并降低严重cGVHD的风险，从而降低死亡率和提高存活率。
Experience using post-transplant cyclophosphamide (PT-Cy) as graft-versus-host disease (GVHD) prophylaxis in allogeneic stem cell transplantation (HSCT) from matched sibling donors (MSD) or unrelated donors (UD) is limited and with controversial results. The study aim was to evaluate PT-Cy as GVHD prophylaxis post-HSCT from MSD and UD transplants. We analyzed 423 patients with acute leukemia who received PT-Cy alone or in combination with other immunosuppressive (IS) drugs as GVHD prophylaxis. Seventy-eight patients received PT-Cy alone (group 1); 204 received PT-Cy in combination with one IS drug—cyclosporine-A (CSA) or methotrexate (MTX) or mycophenolate-mofetil (MMF) (group 2), while 141 patients received PT-Cy in combination with two IS drugs—CSA + MTX or CSA + MMF (group 3). Transplants were performed from 2007 to 2015 and median follow-up was 20 months. Probability of overall survival (OS) at 2 years was 50, 52.2, and 62.4%, for the three groups, respectively, p = 0.06. In multivariate analysis, in comparison to PT-Cy alone, the addition of two IS drugs was associated with reduced risk of extensive cGVHD (HR 0.25, p = 0.02). Use of bone marrow (BM) and anti-thymocyte globulin were independently associated with reduced risk of extensive cGVHD. Prognostic factors for non-relapse mortality (NRM) were the addition of two IS drugs to PT-Cy (HR 0.35, p = 0.04), diagnosis of AML, disease status at transplant, and patient CMV serology. Factors associated with increased OS were the use of PT-Cy with two IS drugs (HR 0.49, p = 0.02), AML, and disease status at transplant. For GVHD prophylaxis in MSD and UD HSCT, the addition of IS drugs to PT-Cy enhances its effect and reduces the risk of severe cGVHD, reducing mortality and improving survival.
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影响因子：
45.3
作者：
Bashey, Asad;Zhang, Mei-Jie;Eapen, Mary
通讯作者：
Eapen, Mary
影响因子：
4.3
作者：
Alousi, Amin M.;Brammer, Jonathan E.;Champlin, Richard E.
通讯作者：
Champlin, Richard E.
移植后环磷酰胺可在HLA - 帕克洛尼斯骨髓移植中耐受性诱导。
影响因子：
4
作者：
Luznik L;O'Donnell PV;Fuchs EJ
通讯作者：
Fuchs EJ
影响因子：
4.3
作者：
Bradstock, Kenneth;Bilmon, Ian;Gottlieb, David
通讯作者：
Gottlieb, David
影响因子：
4.3
作者：
Carnevale-Schianca, Fabrizio;Caravelli, Daniela;Aglietta, Massimo
通讯作者：
Aglietta, Massimo