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异基因造血细胞移植后受者他汀类药物治疗对移植物抗宿主病的影响。

Impact of recipient statin treatment on graft-versus-host disease after allogeneic hematopoietic cell transplantation.

机构信息

Division of Clinical Research, Fred Hutchinson Cancer Research Center, University of Washington, Seattle, Washington 98109, USA.

出版信息

Biol Blood Marrow Transplant. 2010 Oct;16(10):1463-6. doi: 10.1016/j.bbmt.2010.05.006. Epub 2010 May 26.

Abstract

We retrospectively analyzed outcomes among 1206 patients with hematologic malignancies who had hematopoietic cell transplantation (HCT) from HLA-identical siblings (n = 630) or HLA-matched unrelated donors (n = 576) at a single institution between 2001 and 2007 for a correlation between recipient statin use and risk of graft-versus-host disease (GVHD). Among recipients with cyclosporine-based postgrafting immunosuppression (n = 821), statin use at the time of transplant (6%) was associated with a decreased risk of extensive chronic GVHD (cGVHD) (multivariate hazard ratio [HR], 0.62; 95% confidence interval [CI], 0.4-1.0; P = .05) and an increased risk of recurrent malignancy (HR, 1.75; 95% CI, 1.0-3.0; P = .04). Recipient statin use, however, had no apparent impact on the risks of cGVHD and recurrent malignancy among recipients given tacrolimus-based immunosuppression (n = 385; 8% statin treated). Risks of acute GVHD, nonrelapse mortality, and overall mortality were not significantly affected by recipient statin use. Hence, recipient statin treatment at the time of allogeneic HCT may decrease the risk of cGVHD in patients with cyclosporine-based immunosuppression, but at the expense of a compromised graft-versus-tumor effect.

摘要

我们回顾性分析了 2001 年至 2007 年间,1206 名血液系统恶性肿瘤患者在单一机构接受 HLA 相同的同胞(n=630)或 HLA 匹配的无关供体(n=576)造血细胞移植(HCT)的结果,以研究受者他汀类药物使用与移植物抗宿主病(GVHD)风险之间的相关性。在接受环孢素为基础的移植后免疫抑制(n=821)的受者中,移植时使用他汀类药物(6%)与广泛慢性 GVHD(cGVHD)的风险降低相关(多变量危险比[HR],0.62;95%置信区间[CI],0.4-1.0;P=0.05),并且与复发性恶性肿瘤的风险增加相关(HR,1.75;95%CI,1.0-3.0;P=0.04)。然而,在接受他克莫司为基础免疫抑制的 385 名受者中(8%他汀类药物治疗),受者他汀类药物的使用对 cGVHD 和复发性恶性肿瘤的风险没有明显影响。急性 GVHD、非复发死亡率和总死亡率的风险不受受者他汀类药物使用的显著影响。因此,在同种异体 HCT 时,受者他汀类药物治疗可能会降低环孢素为基础免疫抑制患者 cGVHD 的风险,但代价是肿瘤抗移植效果受损。

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