Department of Hematology, Zhuzhou Central Hospital, The Affiliated Zhuzhou Hospital of Xiangya Medical College of Central South University, Zhuzhou, Hunan, China.
Department of Gastroenterology, Shaoyang Hospital of TCM, Shaoyang, Hunan, China.
Expert Rev Hematol. 2020 May;13(5):565-575. doi: 10.1080/17474086.2020.1738214. Epub 2020 Mar 21.
: Authors assessed the impact of ruxolitinib (RUX) on steroid-refractory graft-versus-host disease (SR-GVHD) patients.: Studies published before January 2019 were identified by electronic search of MEDLINE, EMBASE, Cochrane Library, Clinical Trials.Gov and Web of Science databases.: Sixteen cohort studies (414 adults) were included whose methodological quality ranged from poor to good. Pooled outcomes such as the response rates, steroid dose reduction, 1-year overall survival, overall infection, and grade 3 to 4 cytopenia were calculated separately for adults with steroid-refractory acute GVHD (aGVHD) and chronic GVHD (cGVHD). Further, the overall response rates were analyzed according to the affected organ. Adults with aGVHD as well as cGVHD showed high response with RUX, and steroid dose reduction was observed in both cases. Infection rates and cytopenia were important safety concerns for both aGVHD and cGVHD.: Notwithstanding the need of randomized controlled trials to confirm the effect of RUX on SR-GVHD, response rates among adults with aGVHD and cGVHD seem to be high with the use of RUX as a salvage treatment, particularly in cases with gastrointestinal and cutaneous involvement. However, high rates of myelosuppression and infection remain a cause for concern regardless of aGVHD or cGVHD.
作者评估了鲁索利替尼（RUX）对类固醇难治性移植物抗宿主病（SR-GVHD）患者的影响。通过对 MEDLINE、EMBASE、Cochrane 图书馆、ClinicalTrials.gov 和 Web of Science 数据库的电子检索，确定了 2019 年 1 月之前发表的研究。纳入了 16 项队列研究（414 名成年人），其方法学质量从差到好不等。分别计算了成人类固醇难治性急性移植物抗宿主病（aGVHD）和慢性移植物抗宿主病（cGVHD）患者的反应率、类固醇剂量减少、1 年总生存率、总感染率和 3 至 4 级细胞减少症等综合结局。此外，还根据受影响的器官分析了总体反应率。患有 aGVHD 和 cGVHD 的成年人使用 RUX 显示出高反应率，并且在两种情况下都观察到了类固醇剂量减少。感染率和细胞减少症是 aGVHD 和 cGVHD 的重要安全问题。尽管需要随机对照试验来证实 RUX 对 SR-GVHD 的疗效，但使用 RUX 作为挽救治疗，aGVHD 和 cGVHD 患者的反应率似乎很高，尤其是在胃肠道和皮肤受累的情况下。然而，无论是否患有 aGVHD 或 cGVHD，骨髓抑制和感染的高发生率仍然令人担忧。
