Sun Y Q, Huang X J, Xu L P, Zhang X H, Yan C H, Liu K Y, Wang Y
The Institute of Hematology, People's Hospital of Peking University, Beijing 100044, China.
Zhonghua Xue Ye Xue Za Zhi. 2018 Apr 14;39(4):286-291. doi: 10.3760/cma.j.issn.0253-2727.2018.04.005.
To investigate the impact of mycophenolate mofetil (MMF) prophylaxis duration on acute graft-versus-host disease (aGVHD) after haploidentical stem cell transplantation (haplo-HSCT) using 'Beijing Protocol'. Adult patients (≥14 years) received haplo-HSCT in Peking University Institute of Hematology from Sep, 2016 to Mar, 2017 were retrospectively reviewed if they fulfilled the criterias: ①diagnosed with hematological maligancies; ②standard-risk status at haplo-HSCT. A total of 237 patients [including 102 patients with long MMF duration (defined as started on day -9 with 100 mg/d, adjusted to 500 mg/d from day +30 and discontinued on day +45 to +60 or occurrence of CMV/EBV reactivation or late-onset hemorrhagic cytitis), and 135 patients with short MMF duration (defined as started on day -9 with 500 mg/d and discontinued on the day achieved neutrophil engraftment)] were reviewed. The incidence of aGVHD, virus infection and overall survival (OS) were compared between the two groups. The median durations of MMF prophylaxis of long and short duration groups were 27(7-71) and 15(9-24) days, respectively after haplo-HSCT. There were no differences of baseline characteristics (including sex, patient age, disease, mismatched HLA loci, donor-recipient relation, donor-recipient sex and donor age) between the two groups. The incidences of the grade Ⅱ-Ⅳ and Ⅲ/Ⅳ aGVHD in long and short duration groups were 31.1% versus 17.6% (=0.018) and 7.4% verus 7.8% (=0.900), respectively. The duration of MMF prophylaxis was not found to be associated with gradeⅡ-Ⅳ aGVHD by the multivariate analysis. There were no significant differences in terms of CMV viremia, EBV viremia, hemorrhagic cytitis and OS between the two groups. Prophylaxis with short duration MMF in the setting of 'Beijing protocol' haplo-SCT was not associated with increased acute GVHD with no impact on OS, which indicated that short duration MMF might be a feasible GVHD prophylaxis regimen.
为研究霉酚酸酯（MMF）预防用药持续时间对采用“北京方案”的单倍体造血干细胞移植（haplo-HSCT）后急性移植物抗宿主病（aGVHD）的影响。对2016年9月至2017年3月在北京大学血液病研究所接受haplo-HSCT的成年患者（≥14岁）进行回顾性分析，入选标准为：①诊断为血液系统恶性肿瘤；②haplo-HSCT时处于标准风险状态。共纳入237例患者[包括102例MMF用药持续时间长的患者（定义为于-9天开始使用，100mg/d，从+30天起调整为500mg/d，并于+45至+60天停药或出现巨细胞病毒/EB病毒再激活或迟发性出血性膀胱炎），以及135例MMF用药持续时间短的患者（定义为于-9天开始使用，500mg/d，并于中性粒细胞植入当天停药）]。比较两组患者的aGVHD发生率、病毒感染率和总生存率（OS）。haplo-HSCT后，MMF预防用药持续时间长和短的两组患者的中位时间分别为27（7-71）天和15（9-24）天。两组患者的基线特征（包括性别、患者年龄、疾病、HLA错配位点、供受者关系、供受者性别和供者年龄）无差异。MMF用药持续时间长和短的两组患者Ⅱ-Ⅳ级和Ⅲ/Ⅳ级aGVHD的发生率分别为31.1%对17.6%（P=0.018）和7.4%对7.8%（P=0.900）。多因素分析未发现MMF预防用药持续时间与Ⅱ-Ⅳ级aGVHD有关。两组患者在巨细胞病毒血症、EB病毒血症、出血性膀胱炎和OS方面无显著差异。在“北京方案”haplo-SCT中，短疗程MMF预防与急性移植物抗宿主病增加无关，且对OS无影响，这表明短疗程MMF可能是一种可行的移植物抗宿主病预防方案。
