Graduate School of Converging Clinical & Public Health, Ewha Womans University, 52 Ewhayeodae-gil, Seodaemun-gu, Seoul, 03760, Korea.
Department of Pharmacy, Asan Medical Center, 388-1 Pungnap-dong, Songpa-gu, Seoul, 05535, Korea.
BMC Pediatr. 2020 May 11;20(1):206. doi: 10.1186/s12887-020-02125-6.
Achievement of target blood concentrations of cyclosporine (CsA) early after transplantation is known to be highly effective for reducing the incidence of acute graft versus host disease (aGVHD). However, no research has been conducted for predicting aGVHD occurrence with low CsA concentrations at different time periods. The objective of this study was to investigate the risk of aGVHD according to low CsA concentrations at lag days in children with allogenic hematopoietic stem cell transplantation (HSCT).
The records of 61 consecutive children who underwent allogeneic HSCT and received CsA as prophylaxis against aGVHD between May 2012 and March 2015 were retrospectively evaluated. The main outcome was any association between low CsA concentrations at lag days and aGVHD occurrence, which was examined for the first month after transplantation. Mean CsA concentrations at three lag periods were calculated: lag days 0-6, 7-13, and 14-20 before aGVHD occurrence.
Patients whose mean CsA concentrations at lag days 0-6 did not reach the initial target concentration had 11.0-fold (95% confidence interval [CI]: 2.3-51.9) greater incidence of aGVHD. In addition, the AORs of low CsA concentrations at lag days 7-13 and 14-20 for developing aGVHD were 108.2 (95% CI: 7.7-1515.5) and 12.1 (95% CI: 1.1-138.1), respectively.
After low CsA concentrations are detected, careful attention needs to be paid to prevent aGVHD.
移植后早期达到环孢素（CsA）的目标血药浓度，已知对降低急性移植物抗宿主病（aGVHD）的发生率非常有效。然而，尚未研究在不同时间段低 CsA 浓度预测 aGVHD 发生的情况。本研究旨在探讨异基因造血干细胞移植（HSCT）患儿 lag 天低 CsA 浓度与 aGVHD 发生的风险。
回顾性分析 2012 年 5 月至 2015 年 3 月期间接受异基因 HSCT 并接受 CsA 预防 aGVHD 的 61 例连续患儿的记录。主要结局是 lag 天后低 CsA 浓度与 aGVHD 发生之间的任何关联，这在移植后第一个月进行了检查。计算 lag 期 0-6、7-13 和 14-20 天的平均 CsA 浓度：在 aGVHD 发生之前。
lag 天 0-6 平均 CsA 浓度未达到初始目标浓度的患者，aGVHD 的发生率增加了 11.0 倍（95%置信区间 [CI]：2.3-51.9）。此外， lag 天 7-13 和 14-20 时低 CsA 浓度发生 aGVHD 的 OR 值分别为 108.2（95%CI：7.7-1515.5）和 12.1（95%CI：1.1-138.1）。
检测到低 CsA 浓度后，需要密切注意预防 aGVHD。
