Koh Jeong Suk, Lee Myung-Won, Pham Thi Thuy Duong, Heo Bu Yeon, Choi Suyoung, Lee Sang-Woo, Seo Wonhyoung, Kang Sora, Lee Seul Bi, Kim Chul Hee, Ryu Hyewon, Eun Hyuk Soo, Lee Hyo-Jin, Yun Hwan-Jung, Jo Deog-Yeon, Song Ik-Chan
Division of Hematology and Oncology, Department of Internal Medicine, Chungnam National University Hospital, 282 Munwha-Ro, Jung-Gu, Daejeon, 35015, South Korea.
Department of Medical Science, Daejeon, South Korea.
Blood Res. 2025 Jan 15;60(1):5. doi: 10.1007/s44313-024-00049-z.
Post-transplantation cyclophosphamide (PTCy) and anti-thymocyte globulin (ATG) are common prophylactic strategies for graft-versus-host disease (GVHD) after haploidentical hematopoietic stem cell transplantation (haplo-HSCT). Interleukin (IL)-6 is a surrogate marker for cytokine release syndrome (CRS) and acute GVHD.
The clinical outcomes and complications of haplo-HSCT with PTCy plus ATG versus PTCy monotherapy were compared according to serum IL-6 levels at Chungnam National University Hospital (Daejeon, South Korea) from January 2019 to February 2023.
Forty patients who underwent haplo-HSCT were analyzed. A significant difference in IL-6 levels was observed between the PTCy plus ATG and PTCy alone groups (7.47 ± 10.55 vs. 117.65 ± 127.67; p = 0.003). More patients in the PTCy plus ATG group had a CRS grade of 0 than in the PTCy alone group (p < 0.001). Serum IL-6 levels were associated with grades II-IV acute GVHD (r = 0.547, p < 0.001). The cumulative incidence (CI) of grades II-IV acute GVHD was significantly higher in the PTCy alone group (67.9% vs. 4.8%; p < 0.001). No significant difference in the CI for chronic GVHD was detected between the PTCy plus ATG and PTCy alone groups (72.1% vs. 82.0%; p = 0.730). The CI of 1-year non-relapse mortality was significantly higher in the PTCy alone group than in the PTCy plus ATG group (42.2% vs. 15.9%; p = 0.022). The 1-year overall survival (OS) was significantly better in the PTCy plus ATG group (75.9% vs. 35.3%; p = 0.011). The 1-year GVHD-free, relapse-free survival rate was 29.4% in the PTCy alone group and 54.0% in the PTCy plus ATG group (p = 0.038).
Serum IL-6 levels were higher in the PTCy alone group than in the PTCy plus ATG group. The addition of ATG before stem cell infusion affected IL-6 levels and reduced the incidences of CRS and grade II-IV acute GVHD in haplo-HSCT patients. This study suggests that PTCy plus ATG as GVHD prophylaxis in haplo-HSCT is beneficial in terms of clinical outcomes and complications of HSCT.
移植后环磷酰胺（PTCy）和抗胸腺细胞球蛋白（ATG）是单倍体相合造血干细胞移植（haplo-HSCT）后预防移植物抗宿主病（GVHD）的常用策略。白细胞介素（IL）-6是细胞因子释放综合征（CRS）和急性GVHD的替代标志物。
2019年1月至2023年2月，在韩国忠南国立大学医院，根据血清IL-6水平，比较了PTCy联合ATG与PTCy单药治疗haplo-HSCT的临床结局和并发症。
分析了40例行haplo-HSCT的患者。PTCy联合ATG组与PTCy单药组的IL-6水平存在显著差异（7.47±10.55 vs. 117.65±127.67；p=0.003）。PTCy联合ATG组CRS 0级的患者比PTCy单药组更多（p<0.001）。血清IL-6水平与II-IV级急性GVHD相关（r=0.547，p<0.001）。PTCy单药组II-IV级急性GVHD的累积发生率显著更高（67.9% vs. 4.8%；p<0.001）。PTCy联合ATG组与PTCy单药组慢性GVHD的累积发生率无显著差异（72.1% vs. 82.0%；p=0.730）。PTCy单药组1年非复发死亡率的累积发生率显著高于PTCy联合ATG组（42.2% vs. 15.9%；p=0.022）。PTCy联合ATG组1年总生存率显著更好（75.9% vs. 35.3%；p=0.011）。PTCy单药组1年无GVHD、无复发生存率为29.4%，PTCy联合ATG组为54.0%（p=0.038）。
PTCy单药组的血清IL-6水平高于PTCy联合ATG组。在干细胞输注前加用ATG可影响IL-6水平，并降低haplo-HSCT患者CRS和II-IV级急性GVHD的发生率。本研究表明，PTCy联合ATG作为haplo-HSCT中GVHD的预防措施，在HSCT的临床结局和并发症方面是有益的。
