Sayýn Selim, Yýldýrým Murat, Cömert Melda, Uğur Bilge, Yýlmaz Esra Şafak, Avcu Ferit, Ural Ali Uğur, Aylı Meltem
Gülhane Education and Research Hospital, Department of Hematology and Bone Marrow Transplantation Unit, Ankara, Turkey.
Gülhane Educational and Research Hospital, Department of Medical Informatics, Ankara, Turkey.
Mediterr J Hematol Infect Dis. 2024 Mar 1;16(1):e2024016. doi: 10.4084/MJHID.2024.016. eCollection 2024.
The aim of this study was to evaluate whether cyclophosphamide administered after allogeneic stem cell transplantation (ASCT) from 9/10 HLA-Matched Unrelated Donors (MMUD) increases the rates of bacterial, fungal, viral infections, complications (hemorrhagic cystitis (HC)), and infection-related mortality compared to allogeneic stem cell transplantation from matched related donors (MRD).
This is a retrospective multicenter study. 45 MMUD ASCT patients who received posttransplant cyclophosphamide+methotrexate+calcineurin inhibitor compared with 45 MRD ASCT patients who received methotrexate+calcineurin inhibitor.
Although there was a statistically significant prolongation of neutrophil engraftment time in the PTCy arm, there was no statistically significant difference in bacterial infection frequencies between the groups (PTCy; 9 (20%), control; 8 (17.8%), p=0.778). The distribution of CMV infection in the first 100 days was similar (p=0.827), but the distribution of CMV infection rate between the 100th and 365th days was observed more frequently in the control group (p=0.005). HC rates and their grades were similar in both groups (PTCy; 4 (8.8%), control; 6 (13.3%) p=0.502). The rates of VZV infection and invasive aspergillosis were similar in the PTCy and control groups (13.3% in the PTCy and 17.8% in the control group p=0.561). There is also no statistically significant difference in survival analysis (OS, LFS, GRFS, RI, IRM, NRM) between groups. However, the incidence of cGVHD was significantly higher in the control group (P=0.035).
The addition of PTCy to standard GvHD prophylaxis in MMUD ASCT does not lead to an increase in CMV reactivation, bacterial infections, invasive fungal infection, viral hemorrhagic cystitis, or mortality.
本研究的目的是评估与来自匹配相关供者（MRD）的异基因干细胞移植相比，在9/10 HLA匹配的无关供者（MMUD）的异基因干细胞移植（ASCT）后给予环磷酰胺是否会增加细菌、真菌、病毒感染率、并发症（出血性膀胱炎（HC））以及感染相关死亡率。
这是一项回顾性多中心研究。45例接受移植后环磷酰胺+甲氨蝶呤+钙调神经磷酸酶抑制剂的MMUD ASCT患者与45例接受甲氨蝶呤+钙调神经磷酸酶抑制剂的MRD ASCT患者进行比较。
尽管在接受移植后环磷酰胺的组中中性粒细胞植入时间有统计学意义的延长，但两组之间的细菌感染频率无统计学显著差异（移植后环磷酰胺组；9例（20%），对照组；8例（17.8%），p=0.778）。前100天内巨细胞病毒（CMV）感染的分布相似（p=0.827），但在第100天至365天之间，CMV感染率在对照组中观察到更频繁（p=0.005）。两组的HC发生率及其分级相似（移植后环磷酰胺组；4例（8.8%），对照组；6例（13.3%），p=0.502）。移植后环磷酰胺组和对照组的水痘带状疱疹病毒（VZV）感染率和侵袭性曲霉病发生率相似（移植后环磷酰胺组为13.3%，对照组为17.8%，p=0.561）。两组之间的生存分析（总生存期、无白血病生存期、无移植物抗宿主病生存期、复发率、感染相关死亡率、非复发死亡率）也无统计学显著差异。然而，对照组慢性移植物抗宿主病（cGVHD）的发生率显著更高（P=0.035）。
在MMUD ASCT的标准移植物抗宿主病预防中添加移植后环磷酰胺不会导致CMV再激活、细菌感染、侵袭性真菌感染、病毒性出血性膀胱炎或死亡率增加。
