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利妥昔单抗对异基因移植患者发生爱泼斯坦-巴尔病毒血症时慢性移植物抗宿主病的保护作用。

Protective Effect of Rituximab in Chronic Graft-Versus-Host Disease Occurrence in Allogeneic Transplant patients with Epstein Barr Virus Viremia.

作者信息

Ji Shi-Meng, Bao Xie-Bing, Lu Jun, Ma Xiao, Tao Tao, Sun Ai-Ning, Wu De-Pei, Xue Sheng-Li

机构信息

Department of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, China.

Institute of Blood and Marrow Transplantation, Soochow University, Suzhou, China.

出版信息

Indian J Hematol Blood Transfus. 2017 Dec;33(4):525-533. doi: 10.1007/s12288-017-0783-2. Epub 2017 Feb 8.

Abstract

B cells are involved in chronic graft-versus-host disease (cGVHD) pathogenesis, and Rituximab may have a therapeutic effect on cGVHD in allogeneic hematopoietic stem cell transplantation (allo-HSCT) patients. Herein, we retrospectively evaluated the prophylactic effect of Rituximab on cGVHD in a group of Chinese allo-HSCT patients. A total of 102 patients, who suffered Epstein Barr virus (EBV) viremia within 100 days after allo-HSCT, were included in this study. Fifty patients received Rituximab (375 mg/m weekly) for EBV viremia, while fifty-two patients did not receive Rituximab. A competing risk model was adopted to compare cumulative incidence of cGVHD, cumulative incidence of relapse (CIR) and transplantation-related mortality (TRM) between two groups. Cumulative incidence of cGVHD in the Rituximab group was lower than in controls ( = 0.0579). Multivariate analyses confirmed that Rituximab was an independent factor for the reduction of cumulative cGVHD incidence ( = 0.0069). No significant difference was observed in CIR ( = 0.39) or TRM ( = 0.48) between two groups and 2-year OS and DFS were comparable (OS,  = 0.667; DFS,  = 0.571). Administration of Rituximab in the early post-transplantation phase may protect against cGVHD in allo-HSCT patients without increasing CIR or TRM.

摘要

B细胞参与慢性移植物抗宿主病(cGVHD)的发病机制,利妥昔单抗可能对异基因造血干细胞移植(allo-HSCT)患者的cGVHD有治疗作用。在此,我们回顾性评估了利妥昔单抗对一组中国allo-HSCT患者cGVHD的预防作用。本研究纳入了102例在allo-HSCT后100天内发生爱泼斯坦-巴尔病毒(EBV)血症的患者。50例患者因EBV血症接受利妥昔单抗治疗(375mg/m²每周一次),而52例患者未接受利妥昔单抗治疗。采用竞争风险模型比较两组之间cGVHD的累积发生率、复发累积发生率(CIR)和移植相关死亡率(TRM)。利妥昔单抗组的cGVHD累积发生率低于对照组(P = 0.0579)。多变量分析证实,利妥昔单抗是降低cGVHD累积发生率的独立因素(P = 0.0069)。两组之间在CIR(P = 0.39)或TRM(P = 0.48)方面未观察到显著差异,2年总生存率(OS)和无病生存率(DFS)相当(OS,P = 0.667;DFS,P = 0.571)。移植后早期给予利妥昔单抗可能预防allo-HSCT患者发生cGVHD,而不增加CIR或TRM。

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Aberrant B-cell homeostasis in chronic GVHD.慢性移植物抗宿主病中异常的B细胞稳态。
Blood. 2015 Mar 12;125(11):1703-7. doi: 10.1182/blood-2014-12-567834. Epub 2015 Feb 2.

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