Department of Hematology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China.
Department of Emergency, The Third Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China.
Transpl Immunol. 2024 Apr;83:101978. doi: 10.1016/j.trim.2023.101978. Epub 2024 Jan 30.
Allogeneic hematopoietic stem cell transplantation (allo-HSCT) has been identified as the potentially curative treatment for high-risk acute lymphoblastic leukemia (ALL) in adult patients. However, relapse of the disease and/or development of graft-versus-host disease (GVHD) remain to be the most common barriers for successful allo-HSCT. Preclinical studies showed that ruxolitinib, a Janus tyrosine kinase (Jak)1 and Jak2 inhibitor, has a selective anti-GVHD effects while preserving a potent graft-versus-leukemia (GVL) effect. Our study aimed to investigate the efficacy and safety in early application of ruxolitinib for the high-risk ALL patients to prevent GVHD.
There were eight patients undergoing allo-HSCT at the Bone Marrow Transplantation Center of the Third Xiangya Hospital of Central South University between April 2020 and April 2021. Ruxolitinib (5-10 mg twice daily) was administered early (median time: 45 days) after stem cell infusion.
After a median follow-up of 14 months (range from 8 to 18 months), the ALL disease relapse occurred in two cases. Among all eight patients, two of them developed grade I/II acute (a) GVHD, while no patient developed grade III/IV aGVHD, and one patient developed chronic (c) GVHD. As for the virus activation, no patient developed EBV activation or EBV related lymphoproliferative disease, and three patients developed CMV activation. Our results suggest that the early application of ruxolitinib could safely and effectively prevent the occurrence of GVHD after allo-HSCT for the high-risk ALL patients. However, it may have a limited effect on preventing the recurrence of high-risk ALL and thus may require additional therapy with other anti-relapse drugs.
Our preliminary observations suggest that an early application of ruxolitinib can safely and effectively prevent the occurrence of GVHD after allo-HSCT for the high-risk ALL patients. However, ruxolitinib may have a limited effect on preventing the ALL recurrence of high-risk patients.
同种异体造血干细胞移植（allo-HSCT）已被确定为成人高危急性淋巴细胞白血病（ALL）潜在的治愈方法。然而，疾病复发和/或移植物抗宿主病（GVHD）的发展仍然是 allo-HSCT 成功的最常见障碍。临床前研究表明，ruxolitinib 是一种 Janus 酪氨酸激酶（Jak）1 和 Jak2 抑制剂，具有选择性抗 GVHD 作用，同时保持强烈的移植物抗白血病（GVL）作用。我们的研究旨在探讨早期应用 ruxolitinib 预防高危 ALL 患者发生 GVHD 的疗效和安全性。
2020 年 4 月至 2021 年 4 月，中南大学湘雅三医院骨髓移植中心收治 8 例 allo-HSCT 患者。在干细胞输注后早期（中位时间：45 天）给予 ruxolitinib（5-10mg，每日两次）。
中位随访 14 个月（8-18 个月）后，2 例患者发生 ALL 疾病复发。在所有 8 例患者中，2 例发生 1/2 级急性（a）GVHD，无 3/4 级 aGVHD，1 例发生慢性（c）GVHD。对于病毒激活，无患者发生 EBV 激活或 EBV 相关淋巴组织增生性疾病，3 例患者发生 CMV 激活。结果表明，早期应用 ruxolitinib 可安全有效地预防高危 ALL 患者 allo-HSCT 后发生 GVHD。然而，它可能对预防高危 ALL 的复发效果有限，因此可能需要其他抗复发药物的治疗。
我们的初步观察表明，早期应用 ruxolitinib 可安全有效地预防高危 ALL 患者 allo-HSCT 后发生 GVHD。然而，ruxolitinib 可能对预防高危患者 ALL 的复发作用有限。
