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单倍体造血细胞移植联合移植后环磷酰胺治疗后新发移植后糖尿病

New-onset post-transplant diabetes mellitus after haploidentical hematopoietic cell transplant with post-transplant cyclophosphamide.

作者信息

Mangan Brendan L, Patel Dilan, Chen Heidi, Gatwood Katie S, Byrne Michael T, Sengsayadeth Salyka, Goodman Stacey, Dholaria Bhagirathbhai, Kassim Adetola A, Jagasia Madan, Chinratanalab Wichai, Culos Kathryn A, Engelhardt Brian G

机构信息

Department of Pharmacy, Vanderbilt University Medical Center, Nashville, TN, USA.

Division of Hematology and Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.

出版信息

EJHaem. 2020 Nov;1(2):576-580. doi: 10.1002/jha2.70. Epub 2020 Sep 23.

DOI:10.1002/jha2.70
PMID:33709085
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7942195/
Abstract

Haploidentical hematopoietic cell transplant (haplo-HCT) with post-transplant cyclophosphamide (PTCY) is utilized for patients with hematological disorders but without conventional donors. The effects of new-onset post-transplant diabetes mellitus (PTDM) following haplo-HCT are unknown. We examined PTDM incidence and outcomes after haplo-HCT with PTCY. Patients without diabetes receiving haplo-HCT (n=64) were analyzed for PTDM diagnosis (defined as blood glucose≥ 200 mg/dL). By day 100, 14 (22%) patients developed PTDM (median, 18 days). Hyperglycemia (blood glucose ≥ 200 mg/dL) preceded corticosteroids in 11 (79%) individuals. PTDM patients had increased death/relapse (p=0.029). PTDM occurs frequently, precedes corticosteroids, and leads to inferior outcomes following haplo-HCT. PTDM prophylaxis/treatment may improve HCT survival.

摘要

对于患有血液系统疾病但没有常规供体的患者，采用单倍体相合造血细胞移植（haplo-HCT）联合移植后环磷酰胺（PTCY）进行治疗。单倍体相合造血细胞移植后新发移植后糖尿病（PTDM）的影响尚不清楚。我们研究了单倍体相合造血细胞移植联合PTCY后的PTDM发生率及预后情况。对接受单倍体相合造血细胞移植的无糖尿病患者（n = 64）进行PTDM诊断分析（定义为血糖≥200mg/dL）。至第100天时，14例（22%）患者发生PTDM（中位时间为18天）。11例（79%）患者在使用糖皮质激素之前出现高血糖（血糖≥200mg/dL）。PTDM患者的死亡/复发风险增加（p = 0.029）。PTDM在单倍体相合造血细胞移植后频繁发生，出现在使用糖皮质激素之前，并导致较差的预后。PTDM的预防/治疗可能会改善造血细胞移植的生存率。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3887/9176126/ff750e4c9ce7/JHA2-1-576-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3887/9176126/ff750e4c9ce7/JHA2-1-576-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3887/9176126/ff750e4c9ce7/JHA2-1-576-g001.jpg

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本文引用的文献

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Review: Diabetes, Obesity, and Cancer-Pathophysiology and Clinical Implications.综述：糖尿病、肥胖症和癌症的病理生理学及其临床意义。
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Early high plasma ST2, the decoy IL-33 receptor, in children undergoing hematopoietic cell transplantation is associated with the development of post-transplant diabetes mellitus.
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Haematologica. 2020 May;105(5):e249-e252. doi: 10.3324/haematol.2019.222992. Epub 2019 Aug 29.
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