PTCY 联合他克莫司预防 HLA 匹配的同胞供者和无关供者alloHCT 后老年患者的移植物抗宿主病
PTCY and Tacrolimus for GVHD Prevention for Older Adults Undergoing HLA-Matched Sibling and Unrelated Donor AlloHCT.
机构信息
Hematopoietic Transplantation Unit, Hematology Department, Clinical Institute of Hematology and Oncology (ICMHO), Hospital Clínic de Barcelona, Barcelona, Spain.
Hematopoietic Transplantation Unit, Hematology Department, Clinical Institute of Hematology and Oncology (ICMHO), Hospital Clínic de Barcelona, Barcelona, Spain.
出版信息
Transplant Cell Ther. 2022 Aug;28(8):489.e1-489.e9. doi: 10.1016/j.jtct.2022.05.009. Epub 2022 May 14.
The use of post-transplantation cyclophosphamide (PTCY) for graft-versus-host disease (GHVD) prevention is becoming prevalent in the transplantation community when HLA-identical sibling and 10/10 HLA-matched (MUD) and 9/10 mismatched unrelated donors are selected for alloHSCT. However, reported evidence on outcomes from elderly patients receiving PTCY-containing GVHD prophylaxis remains limited. This study aims to compare the outcomes of PTCY- tacrolimus (TK) prophylaxis and conventional GVHD prophylaxis in patients aged >50 years undergoing peripheral blood alloHSCT from a single institution. A total of 161 consecutive patients aged >50 years undergoing alloHSCT between January 2014 and February 2021 were included. Data were collected retrospectively and updated in December 2021. Patients received grafts from HLA-identical sibling, and from 10/10 and 9/10 HLA matched and mismatched unrelated donors. Overall, median age was 60 years, and 91 (54.8%) received PTCY-TK for GVHD prevention. Time to neutrophil and platelet engraftment was longer in the PTCY-TK group (20 versus 16 days and 19 versus 11 days, P < .001). The cumulative incidences of grade II-IV and III-IV acute GVHD (aGVHD) at day 100 and moderate/severe chronic GVHD (cGVHD) at 2 years were 18.2%, 5.7%, and 9.5% for patients receiving PTCY-TK, and 26.0%, 9.6% and 39.5% for those who did not. The multivariate analysis showed that PTCY-TK reduced the probability of grade II-IV aGVHD (hazard ratio [HR] 0.41, P = .035), of cGVHD (any grade: HR 0.43 [P = .014], and of moderate/severe cGVHD [HR 0.15 {P < .001}]). At 2 years, the overall survival (65.4% versus 65.6%, P = .472), non-relapse mortality (17.4% versus 13.7%, P = .967), and cumulative incidence of relapse rates (24.2% versus 27.5%, P = .712) were comparable between both cohorts; GVHD-free/relapse-free survival (GRFS) was higher in the PTCY-TK group (2 years: 50.2% versus 21.8%; HR 0.42, P = .001). In patients aged ≥50 years. PTCY-TK was safe and a more effective drug combination than non-PTCY containing GVHD prophylaxis, even with the use of matched and mismatched unrelated donors, and resulted in comparable relapse rates and better GRFS.
在选择 HLA 完全匹配的同胞供者和 10/10、9/10 错配的无关供者进行alloHSCT 时，移植界越来越多地使用移植后环磷酰胺（PTCY）预防移植物抗宿主病（GVHD）。然而，有关老年患者接受含 PTCY 的 GVHD 预防的结果的报告证据仍然有限。本研究旨在比较单中心接受外周血 alloHSCT 的>50 岁患者中 PTCY-他克莫司（TK）预防和常规 GVHD 预防的结果。共纳入 2014 年 1 月至 2021 年 2 月期间接受 alloHSCT 的>50 岁的 161 例连续患者。数据通过回顾性收集，并于 2021 年 12 月更新。患者接受 HLA 完全匹配的同胞供者、10/10 和 9/10 HLA 匹配和错配的无关供者的移植物。总体而言，中位年龄为 60 岁，91 例（54.8%）接受 PTCY-TK 预防 GVHD。在 PTCY-TK 组，中性粒细胞和血小板植入时间较长（20 天对 16 天和 19 天对 11 天，P<0.001）。在第 100 天，接受 PTCY-TK 的患者的 II-IV 级和 III-IV 级急性 GVHD（aGVHD）以及 2 年时的中度/重度慢性 GVHD（cGVHD）累积发生率分别为 18.2%、5.7%和 9.5%，而未接受 PTCY-TK 的患者分别为 26.0%、9.6%和 39.5%。多变量分析显示，PTCY-TK 降低了 II-IV 级 aGVHD 的概率（风险比[HR]0.41，P=0.035）、cGVHD 的概率（任何等级：HR 0.43[P=0.014]，中度/重度 cGVHD：HR 0.15{ P<0.001}）。2 年时，总生存率（65.4%对 65.6%，P=0.472）、非复发死亡率（17.4%对 13.7%，P=0.967）和复发率的累积发生率（24.2%对 27.5%，P=0.712）在两组之间相当；PTCY-TK 组的无 GVHD/复发无病生存率（GRFS）更高（2 年：50.2%对 21.8%；HR 0.42，P=0.001）。在年龄≥50 岁的患者中，PTCY-TK 是一种安全且有效的药物联合方案，优于不含 PTCY 的 GVHD 预防方案，即使使用匹配和不匹配的无关供者，也可获得相当的复发率和更好的 GRFS。
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