Harvard Medical School, Dana-Farber Cancer Institute, Boston, Massachusetts 02115, USA.
Curr Opin Hematol. 2010 Nov;17(6):500-4. doi: 10.1097/MOH.0b013e32833e5b2e.
Sirolimus is being used increasingly as an immunosuppressant in allogeneic hematopoietic stem cell transplantation. This article reviews recent results in sirolimus-based graft-versus-host disease (GVHD) prophylaxis, as well as outcomes using sirolimus for established acute and chronic GVHD.
In uncontrolled experiments, sirolimus provides good control of steroid-resistant acute or chronic GVHD. Similarly, the addition of sirolimus to GVHD prophylaxis regimens appears to reduce the rate of acute GVHD in the myeloablative and reduced-intensity settings, when used in matched, related, and unrelated donor transplantation. The use of sirolimus in haploidentical transplantation is now being explored as well.
Sirolimus should be considered for use in steroid-resistant acute and chronic GVHD. Sirolimus appears promising as primary prophylaxis for GVHD prevention. Randomized trials are currently being performed to determine whether sirolimus-based immunosuppression is superior to traditional GVHD prophylaxis.
西罗莫司作为一种免疫抑制剂，在异基因造血干细胞移植中被越来越多地应用。本文综述了西罗莫司在移植物抗宿主病（GVHD）预防中的最新结果，以及西罗莫司治疗已确诊的急性和慢性 GVHD 的结果。
在非对照实验中，西罗莫司能很好地控制激素耐药性的急性或慢性 GVHD。同样，在骨髓清除和减低强度预处理的情况下，当用于匹配、相关和无关供者移植时，西罗莫司联合 GVHD 预防方案可降低急性 GVHD 的发生率。西罗莫司在单倍体相合移植中的应用也正在探索中。
西罗莫司应考虑用于治疗激素耐药性的急性和慢性 GVHD。西罗莫司作为 GVHD 预防的主要预防药物具有广阔的应用前景。目前正在进行随机试验，以确定西罗莫司为基础的免疫抑制是否优于传统的 GVHD 预防。
