Department of Immunology, Concord Hospital, Hospital Road, Concord, NSW, 2139, Australia.
Faculty of Medicine, University of Sydney, Sydney, Australia.
Curr Rheumatol Rep. 2021 Apr 24;23(5):30. doi: 10.1007/s11926-021-00996-x.
Recipients of allogeneic hematopoietic stem cell transplantation (HSCT) are at increased risk for inflammatory myositis; histological subsets reported include dermatomyositis, necrotising myopathy and chronic graft-versus-host disease (cGVHD)-related myositis. Though corticosteroids and various immunosuppressive therapies have been used, there is a lack of consensus guidelines dictating therapy.
Recent evidence suggests the fascia as a preferential target in cGVHD myositis, with conditioning regimens promoting fascial microtrauma. Positron emission tomography (PET) can be a useful diagnostic tool, and case reports suggest that the Bruton's tyrosine kinase inhibitor ibrutinib may have therapeutic potential. Emerging therapies include targeted B cell depletion with rituximab, and extracorporeal photophoresis. Clinicians need to be vigilant for the development of inflammatory myositis post-allogeneic HSCT as most patients respond to treatment. Advances in immunohistochemistry to determine the dominant cell type and cytokine profile may enable targeted and individualised therapies.
异基因造血干细胞移植（HSCT）受者发生炎症性肌病的风险增加；报道的组织学亚型包括皮肌炎、坏死性肌病和慢性移植物抗宿主病（cGVHD）相关肌病。尽管已使用皮质类固醇和各种免疫抑制疗法，但缺乏指导治疗的共识指南。
最近的证据表明筋膜是 cGVHD 肌病的优先靶点，预处理方案可促进筋膜微创伤。正电子发射断层扫描（PET）可作为一种有用的诊断工具，病例报告表明布鲁顿酪氨酸激酶抑制剂伊布替尼可能具有治疗潜力。新兴疗法包括用利妥昔单抗靶向 B 细胞耗竭，以及体外光化学疗法。由于大多数患者对治疗有反应，因此临床医生需要警惕异基因 HSCT 后炎症性肌病的发生。免疫组织化学的进步可以确定主要的细胞类型和细胞因子谱，从而实现靶向和个体化治疗。
