University Hospital Basel, Division of Hematology, Basel, Switzerland.
University of Basel, Basel, Switzerland.
Bone Marrow Transplant. 2022 Apr;57(4):613-619. doi: 10.1038/s41409-022-01598-6. Epub 2022 Feb 8.
Cyclosporine A (CsA) is commonly used for Graft versus Host Disease (GvHD) prophylaxis at a recommended starting dose of 3 mg/kg/d: Evidence for the effect of different CsA starting doses on GvHD risk is limited. We therefore estimated the association of 5 mg/kg/d (CsA5) and 3 mg/kg/d (CsA3) CsA starting doses with GvHD risk in two consecutive cohorts of allogeneic hematopoietic cell transplantation (allo-HCT) patients, exploring potential risk factors for incident acute GvHD, with a focus on CsA starting dose. We analyzed 519 patients within CsA5 (n = 153) and CsA3 (n = 366). The cumulative incidence function of acute GvHD grade ≥2 was higher in the CsA3 compared to the CsA5 group (41% vs. 33%, respectively; p = 0.043), without impacting chronic GvHD. In multivariable analysis, a CsA starting dose of 3 mg/kg/d, no ATG use, unrelated donor and high to very high disease risk index were significantly associated with acute GvHD grade ≥2. A higher CsA starting dose of 5 mg/kg/d was independently associated with lower acute GvHD risk, and higher CsA levels in the early period after allo-HCT were reached.
环孢素 A（CsA）通常用于移植物抗宿主病（GvHD）的预防，推荐起始剂量为 3mg/kg/d：关于不同 CsA 起始剂量对 GvHD 风险影响的证据有限。因此，我们在连续两批异基因造血细胞移植（allo-HCT）患者中评估了 5mg/kg/d（CsA5）和 3mg/kg/d（CsA3）CsA 起始剂量与 GvHD 风险的关联，探索了急性 GvHD 的潜在风险因素，重点是 CsA 起始剂量。我们分析了 CsA5 组（n=153）和 CsA3 组（n=366）中的 519 例患者。与 CsA5 组相比，CsA3 组≥2 级急性 GvHD 的累积发生率更高（分别为 41%和 33%；p=0.043），但对慢性 GvHD 没有影响。多变量分析显示，CsA 起始剂量为 3mg/kg/d、无 ATG 应用、无关供体和高至极高疾病风险指数与≥2 级急性 GvHD 显著相关。较高的 CsA 起始剂量 5mg/kg/d 与较低的急性 GvHD 风险相关，并且在 allo-HCT 后早期达到较高的 CsA 水平。
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