Patel Arjun, Murthy Guru Subramanian Guru, Hamadani Mehdi, Szabo Aniko, Knight Jennifer M
Medical College of Wisconsin, Milwaukee, WI, United States.
BMT and Cellular Therapy Program, Medical College of Wisconsin, Milwaukee, WI, United States.
Hematol Oncol Stem Cell Ther. 2023 Apr 4;16(3):209-216. doi: 10.1016/j.hemonc.2021.10.001.
Sympathetic nervous system activation plays a role in the development of acute and chronic graft-versus-host disease (GVHD) following allogeneic hematopoietic cell transplantation (HCT). The primary objective was to compare the cause-specific hazard of grade II-IV and III-IV acute GVHD (aGVHD) and chronic GVHD (cGVHD) in the context of ß-blocker use and type (selective vs. non-selective). Secondary objectives included overall survival (OS), relapse-free survival (RFS), and cumulative incidence of relapse, non-relapse mortality (NRM), and grade II-IV and III-IV aGVHD and cGVHD. The current study included 151 patients ages 18 and older diagnosed with hematological malignancies who underwent reduced intensity conditioning allogeneic HCT from HLA matched related or unrelated donors between January 2014 and 2017. 31 patients were on a ß-blocker of which 71% were on a selective ß-blocker. The incidence of aGVHD was not different among groups. Results show a non-significant trend in the association between ß-blocker use and reduction in the risk of developing cGVHD (cause-specific hazard ratio 0.49, p = 0.060), with no negative impact on survival or relapse. The current data are supportive of a potential ß-adrenergic influence on the pathogenesis of GVHD, consistent with the inflammatory etiology of GVHD and the anti-inflammatory effects of ß-adrenergic antagonists.
交感神经系统激活在异基因造血细胞移植（HCT）后急性和慢性移植物抗宿主病（GVHD）的发生发展中起作用。主要目的是比较在使用β受体阻滞剂及其类型（选择性与非选择性）的情况下，II-IV级和III-IV级急性移植物抗宿主病（aGVHD）及慢性移植物抗宿主病（cGVHD）的特定病因风险。次要目的包括总生存期（OS）、无复发生存期（RFS）、复发累积发生率、非复发死亡率（NRM）以及II-IV级和III-IV级aGVHD和cGVHD。本研究纳入了151例年龄在18岁及以上、被诊断为血液系统恶性肿瘤的患者，这些患者在2014年1月至2017年期间接受了来自HLA匹配的相关或无关供者的减低强度预处理异基因HCT。31例患者使用了β受体阻滞剂，其中71%使用的是选择性β受体阻滞剂。各组间aGVHD的发生率无差异。结果显示，使用β受体阻滞剂与cGVHD发生风险降低之间存在非显著趋势（特定病因风险比0.49，p = 0.060），且对生存或复发无负面影响。目前的数据支持β肾上腺素能对GVHD发病机制可能存在影响，这与GVHD的炎症病因及β肾上腺素能拮抗剂的抗炎作用一致。
