Salas Maria Queralt, Atenafu Eshetu G, Law Arjun Datt, Lam Wilson, Pasic Ivan, Chen Carol, Kim Dennis Dong Hwan, Michelis Fotios V, Gerbitz Armin, Lipton Jeffrey Howard, Mattsson Jonas, Kumar Rajat, Viswabandya Auro
Department of Medicine, Section of Medical Oncology and Hematology, University of Toronto, Toronto, Canada.
Hans Messner Allogeneic Blood and Marrow Transplantation Program, Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada.
Leuk Lymphoma. 2021 Dec;62(14):3373-3383. doi: 10.1080/10428194.2021.1966781. Epub 2021 Aug 26.
This study compares the outcomes before and after reducing the ATG dose from 4.5 to 2 mg/kg, in a combination of PTCy and CsA for GVHD prevention, in 250 patients treated with HLA matched RIC PB-alloHCT (70% received 4.5 mg/kg and 30% received 2 mg/kg). The incidences of grade II-IV and III-IV aGVHD at day +100, and moderate/severe cGVHD at 1-year were 12.6% vs. 20% ( = 0.431), 3.6% vs. 4.5% ( = 0.935), and 10.9% vs. 26.1% ( = 0.480), respectively. PTLD (9.1% vs. 1.3%, = 0.026) and viral infections (30.3% vs. 12%; = 0.001) were lower for those treated with 2 mg/kg of ATG. The reduction of the ATG dose resulted in a comparable OS (2-year: 64.7% vs. 64.7%), GRFS (2-year: 48.0% vs. 44.5%), RFS (2-year: 57.0% vs. 62.0%), and NRM (2-year: 17.8 vs. 14.9). The use of (2 mg/kg) ATG-PTCy-CsA for HLA matched RIC alloHCT results in lower viral infections, and incomparable GVHD preventive effect and survival rates.
本研究比较了250例接受HLA匹配的减低预处理强度外周血异基因造血干细胞移植（70%接受4.5mg/kg，30%接受2mg/kg）的患者，在联合使用PTCy和环孢素A预防移植物抗宿主病（GVHD）时，将抗胸腺细胞球蛋白（ATG）剂量从4.5mg/kg降至2mg/kg前后的结果。在第100天时，II-IV级和III-IV级急性移植物抗宿主病（aGVHD）的发生率，以及1年时中度/重度慢性移植物抗宿主病（cGVHD）的发生率分别为12.6%对20%（P=0.431）、3.6%对4.5%（P=0.935）和10.9%对26.1%（P=0.480）。接受2mg/kg ATG治疗的患者，移植后淋巴细胞增殖性疾病（PTLD）（9.1%对1.3%，P=0.026）和病毒感染（30.3%对12%；P=0.001）发生率较低。ATG剂量的降低导致总生存期（OS，2年：64.7%对64.7%）、无复发生存期（GRFS，2年：48.0%对44.5%）、无病生存期（RFS，2年：57.0%对62.0%）和非复发死亡率（NRM，2年：17.8对14.9）相当。使用（2mg/kg）ATG-PTCy-环孢素A进行HLA匹配的减低预处理强度异基因造血干细胞移植，可降低病毒感染率，且移植物抗宿主病预防效果和生存率相当。
