Liesveld J, Duerst R, Rapoport A, Constine L, Abboud C, Packman C, Wedow L, Zwetsch L, McKenna B, Linder T, Silverman W, Swift S, Rowe J, DiPersio J
Department of Medicine, University of Rochester School of Medicine, Rochester, NY 14642, USA.
Bone Marrow Transplant. 1999 Sep;24(5):511-6. doi: 10.1038/sj.bmt.1701947.
Unrelated donor marrow transplantation is associated with an increased incidence of graft-versus-host disease (GVHD) compared with sibling donor transplants. Forty-one patients undergoing unrelated donor transplants were treated with a GVHD prophylaxis regimen that consisted of continuous infusion cyclosporine from day -1 to 100 days post transplant along with nifedipine, glucocorticoids and short-course methotrexate. The regimen was well-tolerated in this cohort with mostly high risk disease. Fifty-one percent of patients developed acute GVHD, which was grade III-IV in 22% of patients. Six of 22 patients at risk for chronic GVHD developed extensive chronic GVHD, five of whom were adults. In patients <18 years of age, there was a >40% chance of 2 year disease-free survival. Use of continuous infusion cyclosporine with nifedipine as an immunosuppressant and protectant against cyclosporine-induced toxicities in unrelated donor transplants is well-tolerated, and results in acute GVHD incidence favorable to that reported with bolus cyclosporine.
与同胞供体移植相比，无关供体骨髓移植与移植物抗宿主病（GVHD）发病率增加相关。41例接受无关供体移植的患者接受了GVHD预防方案治疗，该方案包括从移植前1天至移植后100天持续输注环孢素，同时联合硝苯地平、糖皮质激素和短疗程甲氨蝶呤。在这个大多为高危疾病的队列中，该方案耐受性良好。51%的患者发生了急性GVHD，其中22%的患者为Ⅲ-Ⅳ级。22例有慢性GVHD风险的患者中有6例发生了广泛性慢性GVHD，其中5例为成年人。在18岁以下的患者中，2年无病生存的几率超过40%。在无关供体移植中，使用持续输注环孢素联合硝苯地平作为免疫抑制剂并预防环孢素诱导的毒性，耐受性良好，且急性GVHD发病率优于推注环孢素报道的结果。
