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低剂量猪抗胸腺细胞球蛋白在 HLA 相合同胞供者移植中的应用前景。

Application prospect of low-dose porcine anti-thymocyte globulin in HLA-matched sibling donor transplantation.

机构信息

State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Chinese Academy of Medical Sciences & Peking Union Medical College, Institute of Hematology & Blood Diseases Hospital, Tianjin, People's Republic of China.

Tianjin Institutes of Health Science, Tianjin, People's Republic of China.

出版信息

Hematology. 2023 Dec;28(1):2212943. doi: 10.1080/16078454.2023.2212943.

Abstract

OBJECTIVE

To investigate the preventive effect of low-dose porcine anti-thymocyte globulin (P-ATG) on graft versus host disease (GVHD) in patients' donors over 40 years old or female donors undergoing HLA-matched sibling donor hematopoietic stem cell transplantation (MSD-HSCT).

METHODS

The clinical data of 30 patients received Low-dose Porcine antithymocyte globulin (P-ATG) as a part of the conditioning regimen (the P-ATG group), while the other 30 patients didn't receive ATG (the Non-ATG group).

RESULTS

There was a significant difference in the incidence of aGVHD ([23.3 (10.1-39.7) %] vs [50.0 (30.8-66.5) %],  = 0.028), grade II-IV aGVHD ([16.7 (5.94-32.1) %] vs [40.0 (22.4-57.0) %],  = 0.049) and chronic GVHD (cGVHD) ([22.4 (6.03-45.1) %] vs [69.0 (43.4-84.8) %],  = 0.001) between two groups. But there was no significant difference in terms of moderate-severe cGVHD ( = 0.129), 1-year relapse rate ( = 0.742), non-relapse mortality ( = 0.237), or overall survival ( = 0.441).

CONCLUSION

The application of low-dose P-ATG in patients/donors over 40 years old or female donors undergoing MSD-HSCT for hematological malignancy can significantly reduce the incidence of aGVHD, grade II-IV aGVHD and cGVHD, doesn't increase the risk of relapse.

摘要

目的

研究小剂量猪抗胸腺细胞球蛋白(P-ATG)对 40 岁以上或女性供者行 HLA 相合同胞供者造血干细胞移植(MSD-HSCT)时移植物抗宿主病(GVHD)的预防作用。

方法

30 例患者接受小剂量猪抗胸腺细胞球蛋白(P-ATG)作为预处理方案的一部分(P-ATG 组),而另外 30 例患者未接受 ATG(非 ATG 组)。

结果

两组间急性移植物抗宿主病(aGVHD)的发生率有显著差异[23.3(10.1-39.7)%] vs [50.0(30.8-66.5)%],  = 0.028),Ⅱ-Ⅳ度 aGVHD[16.7(5.94-32.1)%] vs [40.0(22.4-57.0)%],  = 0.049)和慢性移植物抗宿主病(cGVHD)[22.4(6.03-45.1)%] vs [69.0(43.4-84.8)%],  = 0.001)。但两组间中重度 cGVHD( = 0.129)、1 年复发率( = 0.742)、非复发死亡率( = 0.237)或总生存率( = 0.441)无显著差异。

结论

小剂量 P-ATG 应用于 40 岁以上或女性供者行 MSD-HSCT 治疗血液恶性肿瘤患者/供者,可显著降低 aGVHD、Ⅱ-Ⅳ度 aGVHD 和 cGVHD 的发生率,并不增加复发风险。

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