Hoyt R, Ritchie D S, Roberts A W, Macgregor L, Curtis D J, Szer J, Grigg A P
Department of Clinical Haematology & BMT service, The Royal Melbourne Hospital, Parkville, Victoria, Australia.
Bone Marrow Transplant. 2008 Apr;41(7):651-8. doi: 10.1038/sj.bmt.1705955. Epub 2008 Jan 7.
The utility of GVHD prophylaxis with cyclosporin, MTX and prednisolone (CSA/MTX/Pred) in allogeneic PBPC transplants is not well described although there are published data using this combination after bone marrow transplants. The effectiveness of this regimen on the prevention of GVHD was assessed in 107 consecutive sibling and less-than-ideal donor transplant recipients over a 5-year period and compared to that observed in 65 patients receiving standard CSA and short-course MTX without prednisolone. Oral prednisolone was commenced on day +14 at 0.5 mg/kg per day, increased to 1 mg/kg per day on day +21 to day +34 then gradually tapered and ceased by day +100. The cumulative incidence of acute GVHD (grades II-IV) to day 100 in those receiving prednisolone prophylaxis was lower (52 versus 76%, P<0.01). The onset of symptomatic GVHD requiring systemic treatment was delayed from a median of 41 days post transplant to 92 days. When assessment of the cumulative incidence of symptomatic GVHD continued to day +180 incidence became similar (74 versus 78%), there was no difference between the two groups in rates of relapse, transplant-related mortality, infections or chronic GVHD. We conclude that the addition of prednisolone to CSA/MTX delays the onset of early acute GVHD in PBPC recipients but has no impact on the overall incidence of GVHD.
尽管已有关于骨髓移植后使用环孢素、甲氨蝶呤和泼尼松龙（CSA/MTX/Pred）预防移植物抗宿主病（GVHD）的公开数据，但在异基因外周血干细胞移植中，该方案的效用尚未得到充分描述。在5年期间，对107例连续的同胞及非理想供体移植受者评估了该方案预防GVHD的有效性，并与65例接受标准CSA和短疗程MTX且未使用泼尼松龙的患者进行了比较。口服泼尼松龙于+14天开始，剂量为每天0.5mg/kg，在+21天至+34天增加至每天1mg/kg，然后逐渐减量，至+100天停药。接受泼尼松龙预防的患者至100天时急性GVHD（II-IV级）的累积发生率较低（52%对76%，P<0.01）。需要全身治疗的有症状GVHD的发病时间从中位移植后41天延迟至92天。当对有症状GVHD的累积发生率持续评估至+180天时，发生率变得相似（74%对78%），两组在复发率、移植相关死亡率、感染率或慢性GVHD方面无差异。我们得出结论，在CSA/MTX方案中添加泼尼松龙可延迟PBPC受者早期急性GVHD的发病，但对GVHD的总体发生率无影响。
