Xue Ling, Song Lin, Yu Xun, Yang Xiao, Xia Fan, Ding Xiaoliang, Huang Chenrong, Wu Depei, Miao Liyan
Department of Pharmacy, The First Affiliated Hospital of Soochow University, Suzhou, China.
Department of Pharmacology, Faculty of Medicine, University of the Basque Country - (UPV/EHU), Leioa, Spain.
Ther Adv Hematol. 2023 Oct 21;14:20406207231205406. doi: 10.1177/20406207231205406. eCollection 2023.
Acute graft--host disease (aGVHD) is a major complication following hematopoietic stem cell transplantation (HSCT).
This study aimed to explore the risk factors for the incidence of aGVHD in patients post-HSCT.
This was a retrospective study.
A total of 407 patients were enrolled. The patients' data were recorded from the medical records. The exposure of cyclosporine was estimated based on a population pharmacokinetics model. The occurrence of aGVHD was clinically graded and staged in severity from grades I to IV. A proportional odds model that estimated the cumulative probabilities of aGVHD was used to analyze the data using a nonlinear mixed-effects model. Then, the model parameters and plausibility were evaluated by bootstrap and visual predictive checks.
The typical probabilities were 18.9% and 17.9% for grade II and grades III-IV, respectively. The incidence of grade II and grade III-IV aGVHD for human leukocyte antigen (HLA) haplo sibling donor patients was higher than that for HLA-matched donor patients. The incidence of grade II and grade III-IV aGVHD decreased with increasing early cyclosporine trough concentration; however, cyclosporine exposure was not associated with the incidence of aGVHD.
HLA matching and early cyclosporine trough concentration were important factors for the occurrence of aGVHD.
急性移植物抗宿主病（aGVHD）是造血干细胞移植（HSCT）后的主要并发症。
本研究旨在探讨HSCT术后患者发生aGVHD的危险因素。
这是一项回顾性研究。
共纳入407例患者。从病历中记录患者的数据。基于群体药代动力学模型估算环孢素的暴露量。aGVHD的发生根据临床分级和严重程度分为I至IV级。使用估计aGVHD累积概率的比例优势模型，通过非线性混合效应模型分析数据。然后，通过自抽样法和可视化预测检验评估模型参数和合理性。
II级和III-IV级的典型概率分别为18.9%和17.9%。人类白细胞抗原（HLA）单倍体同胞供者患者的II级和III-IV级aGVHD发生率高于HLA匹配供者患者。II级和III-IV级aGVHD的发生率随早期环孢素谷浓度的升高而降低；然而，环孢素暴露与aGVHD的发生率无关。
HLA匹配和早期环孢素谷浓度是发生aGVHD的重要因素。
