低剂量抗胸腺细胞球蛋白联合低剂量移植后环磷酰胺，联合环孢素和霉酚酸酯，用于预防 HLA 匹配的无关供体外周血造血干细胞移植后移植物抗宿主病。

Low-dose antithymocyte globulin plus low-dose posttransplant cyclophosphamide combined with cyclosporine and mycophenolate mofetil for prevention of graft-versus-host disease after HLA-matched unrelated donor peripheral blood stem cell transplantation.

机构信息

Department of Hematology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.

Engineering Technology Research Center of Cell Therapy and Clinical Translation, Shanghai Science and Technology Committee (STCSM), Shanghai, China.

出版信息

Bone Marrow Transplant. 2021 Oct;56(10):2423-2431. doi: 10.1038/s41409-021-01358-y. Epub 2021 May 25.

DOI:10.1038/s41409-021-01358-y

PMID:34035462

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8486671/

Abstract

The standard regimens for graft-versus-host disease (GvHD) prophylaxis in matched unrelated donor (MUD) transplantation were based on antithymocyte globulin (ATG) in combination with calcineurin inhibitors (CNIs). To improve the efficiency of GvHD prophylaxis in MUD peripheral blood stem cell transplantation (MUD-PBSCT), 51 patients with hematological malignancies received a novel regimen for GvHD prophylaxis, which is composed of low dose of ATG (5 mg/kg) plus low-dose posttransplant cyclophosphamide (PTCy, 50 mg/kg) (low-dose ATG/PTCy) combined with cyclosporine A (CsA) and mycophenolate mofetil (MMF). The cumulative incidences (CIs) of grades I-IV and II-IV acute GvHD (aGvHD) were 14.5% (95% CI, 9.4-19.6%) and 6.2% (95% CI, 2.8-9.6%) within 100 days after transplantation, respectively. The CI of mild-to-moderate chronic GvHD (cGvHD) within 1 year was 11.5% (95% CI, 6.6-16.4%). The 1-year probabilities of GvHD and relapse-free survival, relapse-free survival, and over survival were 70.6% (95% CI, 64.2-77.0%), 76.5% (95% CI, 70.6-82.4%), and 82.0% (95% CI, 76.5-87.5%), respectively. The CIs of CMV and EBV reactivation by day 180 were 10.4% (95% CI, 1.5-19.4%) and 8.3% (95% CI, 0.2-16.4%), respectively. The results suggested that low-dose ATG/PTCy combined with CsA/MMF as GvHD prophylaxis in MUD-PBSCT had promising activity.

摘要

在异基因无关供者（MUD）移植中，移植物抗宿主病（GvHD）的标准预防方案基于抗胸腺细胞球蛋白（ATG）联合钙调神经磷酸酶抑制剂（CNIs）。为了提高 MUD 外周血造血干细胞移植（MUD-PBSCT）中 GvHD 预防的效率，51 例血液系统恶性肿瘤患者接受了一种新的 GvHD 预防方案，该方案由低剂量 ATG（5mg/kg）+低剂量移植后环磷酰胺（PTCy，50mg/kg）（低剂量 ATG/PTCy）联合环孢素 A（CsA）和霉酚酸酯（MMF）组成。移植后 100 天内，Ⅰ-Ⅳ级和Ⅱ-Ⅳ级急性 GvHD（aGvHD）的累积发生率（CI）分别为 14.5%（95%CI，9.4-19.6%）和 6.2%（95%CI，2.8-9.6%）。1 年内轻度至中度慢性 GvHD（cGvHD）的 CI 为 11.5%（95%CI，6.6-16.4%）。GvHD、无复发生存、无复发生存和总生存的 1 年概率分别为 70.6%（95%CI，64.2-77.0%）、76.5%（95%CI，70.6-82.4%）和 82.0%（95%CI，76.5-87.5%）。第 180 天 CMV 和 EBV 再激活的 CI 分别为 10.4%（95%CI，1.5-19.4%）和 8.3%（95%CI，0.2-16.4%）。结果表明，低剂量 ATG/PTCy 联合 CsA/MMF 作为 MUD-PBSCT 中的 GvHD 预防方案具有良好的活性。