Division of Clinical Hematology, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, Barcelona, Spain.
Bone Marrow Transplant. 2010 Sep;45(9):1449-56. doi: 10.1038/bmt.2009.362. Epub 2010 Feb 8.
Mycophenolate mofetil (MMF) in combination with CsA seems to lead to earlier post transplant hematological recovery and less mucositis than MTX, with a similar incidence of GVHD. In this study we analyzed the post transplant outcomes of two cohorts of patients who underwent an HLA-identical sibling reduced intensity conditioning transplantation (allo-RIC) with GVHD prophylaxis consisting of CsA in combination with either MMF or a short course of MTX. We included 145 consecutive allo-RIC transplants performed between April 2000 and August 2007. The median follow-up for survivors was 41 months (4-105 months). The study group included 91 males. Median age was 55 years (range 18-71 years). Diagnoses included myeloid (n=65) and lymphoid (n=80) malignancies. GVHD prophylaxis consisted of CsA/MMF in 52 and CsA/MTX in 93 patients. The conditioning regimen was based on fludarabine in combination with BU (n=59) or melphalan (n=86). The occurrence of grade 2-4 mucositis was higher in the CsA/MTX group than in the CsA/MMF group (57 vs 23%, P=0.001). The cumulative incidence of acute and chronic GVHD was similar, 48 vs 50% and 71 vs 68%, respectively (P>0.7). The 2-year relapse and OS were similar in the CsA/MTX and CsA/MMF groups (29 vs 21%, P=0.3 and 52 vs 51%, P=0.7, respectively). Our results support further prospective studies comparing the use of the CsA/MMF combination with CsA/MTX as GVHD prophylaxis in HLA-identical sibling donor allo-RIC recipients.
霉酚酸酯（MMF）联合环孢素（CsA）似乎比甲氨蝶呤（MTX）更早地促进移植后血液学恢复，且口腔黏膜炎发生率较低，移植物抗宿主病（GVHD）发生率也相似。在这项研究中，我们分析了接受 HLA 同胞亲缘全相合减低强度预处理（allo-RIC）移植的两批患者的移植后结局，GVHD 预防方案采用 CsA 联合 MMF 或短程 MTX。我们纳入了 2000 年 4 月至 2007 年 8 月期间进行的 145 例连续 allo-RIC 移植。幸存者的中位随访时间为 41 个月（4-105 个月）。研究组包括 91 例男性，中位年龄为 55 岁（范围 18-71 岁）。诊断包括髓系（n=65）和淋巴系（n=80）恶性肿瘤。GVHD 预防方案包括 CsA/MMF 组 52 例和 CsA/MTX 组 93 例。预处理方案基于氟达拉滨联合 BU（n=59）或马法兰（n=86）。发生 2-4 级口腔黏膜炎的患者在 CsA/MTX 组多于 CsA/MMF 组（57%比 23%，P=0.001）。急性和慢性 GVHD 的累积发生率相似，分别为 48%比 50%（P＞0.7）和 71%比 68%（P＞0.7）。CsA/MTX 组和 CsA/MMF 组的 2 年复发率和 OS 相似（29%比 21%，P=0.3 和 52%比 51%，P=0.7）。我们的结果支持进一步开展前瞻性研究，比较 CsA/MMF 联合方案与 CsA/MTX 作为 HLA 同胞亲缘供者 allo-RIC 受者 GVHD 预防方案的效果。
