造血干细胞移植治疗获得性再生障碍性贫血后他克莫司与环孢素的比较
Tacrolimus versus Cyclosporine after Hematopoietic Cell Transplantation for Acquired Aplastic Anemia.
作者信息
Inamoto Yoshihiro, Flowers Mary E D, Wang Tao, Urbano-Ispizua Alvaro, Hemmer Michael T, Cutler Corey S, Couriel Daniel R, Alousi Amin M, Antin Joseph H, Gale Robert Peter, Gupta Vikas, Hamilton Betty K, Kharfan-Dabaja Mohamed A, Marks David I, Ringdén Olle T H, Socié Gérard, Solh Melhem M, Akpek Görgün, Cairo Mitchell S, Chao Nelson J, Hayashi Robert J, Nishihori Taiga, Reshef Ran, Saad Ayman, Shah Ami, Teshima Takanori, Tallman Martin S, Wirk Baldeep, Spellman Stephen R, Arora Mukta, Martin Paul J
机构信息
Division of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan.
Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington.
出版信息
Biol Blood Marrow Transplant. 2015 Oct;21(10):1776-82. doi: 10.1016/j.bbmt.2015.05.023. Epub 2015 May 30.
Combinations of cyclosporine (CSP) with methotrexate (MTX) have been widely used for immunosuppression after allogeneic transplantation for acquired aplastic anemia. We compared outcomes with tacrolimus (TAC)+MTX versus CSP+MTX after transplantation from HLA-identical siblings (SIB) or unrelated donors (URD) in a retrospective cohort of 949 patients with severe aplastic anemia. Study endpoints included hematopoietic recovery, graft failure, acute graft-versus-host disease (GVHD), chronic GVHD, and mortality. TAC+MTX was used more frequently in older patients and, in recent years, in both SIB and URD groups. In multivariate analysis, TAC+MTX was associated with a lower risk of mortality in URD recipients and with slightly earlier absolute neutrophil count recovery in SIB recipients. Other outcomes did not differ statistically between the 2 regimens. No firm conclusions were reached regarding the relative merits of TAC+MTX versus CSP+MTX after hematopoietic cell transplantation for acquired aplastic anemia. Prospective studies would be needed to determine whether the use of TAC+MTX is associated with lower risk of mortality in URD recipients with acquired aplastic anemia.
环孢素（CSP）与甲氨蝶呤（MTX）联合用药已广泛用于异基因移植治疗获得性再生障碍性贫血后的免疫抑制。在一项对949例重型再生障碍性贫血患者的回顾性队列研究中，我们比较了接受来自 HLA 相同同胞（SIB）或无关供者（URD）移植后，他克莫司（TAC）+MTX与CSP+MTX的疗效。研究终点包括造血恢复、移植失败、急性移植物抗宿主病（GVHD）、慢性GVHD和死亡率。TAC+MTX在老年患者中使用更为频繁，近年来在SIB和URD组中均如此。在多变量分析中，TAC+MTX与URD受者较低的死亡风险相关，与SIB受者绝对中性粒细胞计数稍早恢复相关。两种治疗方案的其他结局在统计学上无差异。对于获得性再生障碍性贫血造血细胞移植后TAC+MTX与CSP+MTX的相对优势，尚未得出明确结论。需要进行前瞻性研究以确定使用TAC+MTX是否与获得性再生障碍性贫血URD受者较低的死亡风险相关。
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