移植后循环胺基移植与宿主疾病预防
Javier Bolaños-Meade1, Mehdi Hamadani1, Juan Wu1
1From the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, and the Department of Oncology, Johns Hopkins University School of Medicine, Baltimore (J.B.-M., R.J.J.), Emmes, Rockville (J.W., K.A.), and the Division of Blood Diseases and Resources (N.L.D.) and the Office of Biostatistics Research (E.L.), National Heart, Lung, and Blood Institute, Bethesda - all in Maryland; the Blood and Marrow Transplant Program and Cellular Therapy Program (M.H.) and the Center for International Blood and Marrow Transplant Research (CIBMTR), Department of Medicine (M.H., M.M.H.), the CIBMTR Division of Biostatistics, Institute for Health and Equity (M.J.M.), and the Division of Hematology and Oncology, Department of Medicine (L.R.), Medical College of Wisconsin, Milwaukee, and the Division of Hematology and Oncology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison (A.C.H.) - both in Wisconsin; the Division of Blood and Marrow Transplantation and Cellular Therapy, Department of Medicine, Stanford University School of Medicine, Stanford (A.R.R.), the Department of Hematology and Hematopoietic Cell Transplantation, City of Hope (M.M.A.M.), and the Department of Pharmacy, City of Hope National Medical Center (J.M.Y.), Duarte, and the Division of Hematology, Departments of Medicine and Genetics, Stanford University, Palo Alto (A.S.B.) - all in California; the Department of Blood and Marrow Transplant and Cellular Immunotherapy, H. Lee Moffitt Cancer and Research Institute, Tampa, FL (H.E.); the Department of Hematology and Oncology, Dana-Farber Cancer Institute (M.G., L.S.K.), and the Department of Pediatrics, Harvard Medical School, and the Division of Pediatric Hematology and Oncology, Boston Children's Hospital (L.S.K.) - all in Boston; the Ohio State University Comprehensive Cancer Center, Columbus (K.T.L., Y.A.E.); Adult Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College (B.C.S., M.-A.P.), and the Blood and Marrow Transplantation Program, Columbia University Irving Medical Center (R.R.) - all in New York; the Division of Hematology, Oncology, and Transplantation, University of Minnesota, Minneapolis (N.E.J., S.G.H.); the Division of Hematology and Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia (A.W.L.); the Blood and Marrow Transplant Program at Northside Hospital, Atlanta (M.S.); the Department of Stem Cell Transplantation and Cellular Therapy, the University of Texas M.D. Anderson Cancer Center, Houston (A.M.A.); the Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham (O.H.J.); and the Division of Hematology-Oncology and Palliative Care, Department of Medicine, Virginia Commonwealth University, Richmond (W.C.).
与标准的塔克罗利木斯和甲基甲治疗方案相比,新的一种循环胺,塔克罗利木斯和甲基甲酸的预防疗法显著改善了同源干细胞移植后无移植对宿主疾病 (GVHD) 的无复发的生存率.
科学领域:
- 血液学 血液学 血液学
- 免疫学 免疫学 免疫学
- 移植医学 移植医学
背景情况:
- 在全源造血干细胞移植 (HSCT) 后的移植对宿主疾病 (GVHD) 预防中,传统上使用氨酸抑制剂加上甲醇.
- 一项第二阶段研究表明,移植后的循环胺,塔克罗利斯和mycophenolate mofetil的治疗方案可能更好.
研究的目的:
- 为了比较循环胺-塔克罗利斯-基酸莫菲蒂尔与塔克罗利斯-甲基酸对接受HSCT的成年人GVHD预防的疗效.
主要方法:
- 一项3期试验随机选择了431名患有血液癌症的成年人接受实验性 (cyclophosphamide-tacrolimus-mycophenolate mofetil) 或标准 (tacrolimus-methotrexate) 预防.
- 患者在减少强度调节后从HLA匹配的相关或7/8不匹配的非相关捐赠者接受HSCT.
- 主要终点是1年后无GVHD,无复发的生存期.
主要成果:
- 在1年内,无GVHD,无复发的生存率在实验组 (52.7%) 与标准组 (34.9%) 相比显著更高.
- 实验方案显示,急性或慢性GVHD,复发或死亡的风险降低 (HR,0.64;P=0.001).
- 接受实验性预防的患者经历了不太严重的GVHD和更高的无免疫抑制生存率.
结论:
- 环胺 - 塔克罗利斯 - 基酸莫菲蒂尔是GVHD的优越预防策略,用于接受全源性HSCT和降低强度调节的患者.
- 这种疗法显著改善了与标准塔克罗利斯-甲托雷克萨特相比,无GVHD,无复发的生存率.
- 这些发现支持在临床实践中使用这种新的治疗方案,用于HSCT接受者.
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