Department of Hematology, Stem Cell Transplantation Unit, University of Health Sciences,Ankara Oncology Training and Research Hospital, Ankara, Turkey.
Sci Rep. 2019 Feb 14;9(1):2046. doi: 10.1038/s41598-019-38644-1.
Post-transplant cyclophosphamide has become a promising medical option after allogeneic HSCT. In this study we aimed to evaluate the efficacy of cyclophosphamide and cyclosporine combination in acute and chronic graft-versus-host disease (GvHD) prophylaxis in acute myeloid leukemia (AML) cases scheduled for allogeneic hematopoietic stem cell transplantation (allo-HSCT). Retrospective analysis of data from 40 cases who underwent allogeneic HSCT under GvHD prophylaxis with cyclophosphamide and cyclosporine combination between April 2016 and August 2017 was made. Cyclophosphamide was given at daily doses of 50 mg/kg on post-transplant 3 and 4 days, and cyclosporine was applied at daily doses of 3 mg/kg/day starting from the 5 post-transplant day. Cyclosporine dose was tapered beginning from the 45 postoperative day and completely discontinued on the 90 post-transplant day. Mean age was 38.25 ± 15.25 years. Posttransplant median follow-up was six months (6-17 months). Post-transplant, the number of deaths and mortality rates related and unrelated to transplantation were 5 (12.5%), and 2 (5%), respectively. Acute GvHD was diagnosed in 7 cases (17.5%), and relapse was noted in 9 cases (22.5%). Myeloablative or reduced intensity conditioning was performed in 22 (55%) and 18 (45%) patients, respectively. The distribution of the donors was as follows: match-related (n = 26; 65%), match-unrelated (n = 9, 22.5%) and haploidentical donors (n = 5; 12.5%). There was no statistically significant correlation between the transplant-related and unrelated mortality and parameters under investigation.Cyclophosphamide use appears to be a highly effective and promising strategy for acute GvHD prophylaxis in non-haploidentical allogeneic HSCT cases. Identification of the impact of cyclophosphamide use on the development of chronic GvHD needs further investigation.
移植后环磷酰胺已成为异基因 HSCT 后有前途的医学选择。本研究旨在评估环磷酰胺和环孢素联合用于预防急性髓系白血病（AML）患者异基因造血干细胞移植（allo-HSCT）后急性和慢性移植物抗宿主病（GvHD）的疗效。对 2016 年 4 月至 2017 年 8 月期间接受环磷酰胺和环孢素联合预防 GvHD 的 40 例 allo-HSCT 患者的数据进行回顾性分析。环磷酰胺在移植后 3 天和 4 天每天给予 50mg/kg，环孢素从移植后第 5 天开始每天给予 3mg/kg。从术后第 45 天开始逐渐减少环孢素剂量，并在移植后第 90 天完全停用。平均年龄为 38.25±15.25 岁。移植后中位随访时间为 6 个月（6-17 个月）。移植后死亡人数和与移植相关及无关的死亡率分别为 5 例（12.5%）和 2 例（5%）。7 例（17.5%）诊断为急性 GvHD，9 例（22.5%）复发。行清髓或减低强度预处理的患者分别为 22 例（55%）和 18 例（45%）。供者分布如下：亲缘（n=26；65%）、非亲缘（n=9，22.5%）和半相合供者（n=5；12.5%）。移植相关和无关死亡率与研究参数之间无统计学显著相关性。环磷酰胺的使用似乎是预防非半相合异基因 HSCT 后急性 GvHD 的一种非常有效和有前途的策略。需要进一步研究环磷酰胺使用对慢性 GvHD 发展的影响。
