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抗 T 淋巴细胞球蛋白剂量对非亲缘异基因外周血造血干细胞移植中移植物抗宿主病和免疫重建的影响。

Impact of Anti-T-lymphocyte globulin dosing on GVHD and Immune reconstitution in matched unrelated myeloablative peripheral blood stem cell transplantation.

机构信息

Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.

出版信息

Bone Marrow Transplant. 2022 Oct;57(10):1548-1555. doi: 10.1038/s41409-022-01666-x. Epub 2022 Jul 13.

Abstract

Data on the influence of different Anti-lymphocyte globulin (ATLG) doses on graft versus host disease (GVHD) incidence and immune reconstitution in matched unrelated (MUD) allogeneic Stem cell transplantation (allo-SCT) is limited. This retrospective study conducted at the University Medical-Center Hamburg compares GVHD and Immune reconstitution after myeloablative MUD (HLA 10/10) PBSC allogeneic stem cell transplant between 30 mg/Kg (n = 73) and 60 mg/Kg (n = 216) ATLG. Detailed phenotypes of T, B natural killer (NK), natural killer T (NKT) cells were analyzed by multicolor flow at day 30, 100, and 180 posttransplant. Neutrophil and platelet engraftments were significantly delayed in the 60 mg/kg group with a higher Cumulative incidence of Infections (67% vs 75% p = 0.049) and EBV (21% vs 41% p = 0.049) reactivation at day 100 in this group. In the 30 mg/kg group, we observed a faster reconstitution of naïve-B cells (p < 0.0001) and γδ T cells (p = 0.045) at day+30 and a faster naïve helper T-cell (p = 0.046), NK-cells (p = 0.035), and naïve B-cell reconstitution (p = 0.009) at day+180. There were no significant differences in aGVHD, cGVHD, NRM, RI, PFS, and OS between the groups. The choice of ATLG dose has significant impact on IR but not on GVHD after MUD-allo-SCT. Higher doses are associated with delayed engraftment and increased infections.

摘要

有关不同抗淋巴细胞球蛋白(ATLG)剂量对移植物抗宿主病(GVHD)发生率和匹配无关供体(MUD)异基因造血干细胞移植(allo-SCT)中免疫重建影响的数据有限。这项在汉堡大学医学中心进行的回顾性研究比较了接受清髓性 MUD(HLA 10/10)PBSC 异基因造血干细胞移植后,30mg/kg(n=73)和 60mg/kg(n=216)ATLG 治疗的患者的 GVHD 和免疫重建情况。在移植后第 30、100 和 180 天,通过多色流式细胞术分析 T、B、自然杀伤(NK)、自然杀伤 T(NKT)细胞的详细表型。在 60mg/kg 组中,中性粒细胞和血小板植入明显延迟,该组第 100 天累积感染发生率(67%比 75%,p=0.049)和 EBV(21%比 41%,p=0.049)明显更高。在 30mg/kg 组中,我们观察到第 30 天 naïve-B 细胞(p<0.0001)和γδ T 细胞(p=0.045)更快的重建,以及第 180 天 naïve 辅助 T 细胞(p=0.046)、NK 细胞(p=0.035)和 naïve B 细胞更快的重建(p=0.009)。两组间急性移植物抗宿主病(aGVHD)、慢性移植物抗宿主病(cGVHD)、非复发死亡率(NRM)、复发率(RI)、无进展生存率(PFS)和总生存率(OS)无显著差异。ATLG 剂量的选择对 MUD-allo-SCT 后的 IR 有显著影响,但对 GVHD 无显著影响。较高的剂量与植入延迟和感染增加相关。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7439/9532245/ea9ef1c6d23e/41409_2022_1666_Fig1_HTML.jpg

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