环胺和西奥特巴增加了移植相关的血栓微血管病变的风险
Christine S Higham1, Kristin A Shimano2, Sandhya Kharbanda1
1Division of Pediatric Allergy, Immunology, and Bone Marrow Transplant, University of California San Francisco, Benioff Children's Hospitals, San Francisco, California.
Transplantation and cellular therapy
|June 29, 2024
概括
循环胺和铁 (CY + TT) 调节的组合显著增加了在血液细胞移植 (HCT) 后的移植相关的血栓性微血管病变 (TA-TMA) 风险. 在调节方案中避免CY + TT可能会减少TA-TMA的发生率.
科学领域:
- 血液学 血液学 血液学
- 在瘤学瘤学.
- 移植医学 移植医学
背景情况:
- 移植相关的血栓性微血管病变 (TA-TMA) 是血造细胞移植 (HCT) 的严重并发症,与内皮损伤有关,导致显著的发病率和死亡率.
- 骨髓损伤性调节方案是TA-TMA的已知风险因素,但具体的致病因子仍未确定.
- 据假设,环胺和西奥特巴 (CY + TT) 的组合特别具有内皮毒性,可能会增加TA-TMA风险.
研究的目的:
- 调查调节方案之间的关联,特别是循环胺和西奥特帕 (CY + TT) 的组合,以及在接受HCT的儿科和年轻成人患者中与移植相关的血栓性微血管病变 (TA-TMA) 的发生率.
- 为了确定导致TA-TMA在HCT后发展的风险因素.
主要方法:
- 在2012年至2023年8月期间接受了自主性或异源性HCT的儿科和年轻成人患者的回顾性审查.
- 卡普兰-梅尔分析以估计TA-TMA的一年累积发病率.
- 使用日志等级测试和考克斯回归模型进行单变量和双变量分析,以评估风险因素,包括调节剂 (CY + TT),病毒和真菌感染.
主要成果:
- 一年内TA-TMA的累积发病率总体为8.6%,在异性 (11.7%) 与自身 (7.2%) 的HCT中,发病率更高.
- 在异构HCT中,CY+TT条件与TA-TMA发生率 (35.7%) 与单独CY或TT (11.7%) 或两者都不是代理 (1.2%) 相比显著更高 (P<.001).
- CY + TT条件 (HR = 35.93),病毒感染 (HR = 4.3) 和真菌感染 (HR = 2.98) 是TA-TMA的重要危险因素. 具有CY+TT的自主HCT显示了19.6%的TA-TMA发生率,特别是在CMV阳性患者中 (38.1%).
结论:
- 作为调节方案的一部分,环胺和铁 (CY + TT) 的组合显著增加了与移植相关的血栓性微血管病变 (TA-TMA) 的发生率,无论是全源的还是自身的HCT接受者.
- 病毒和真菌感染也会增加TA-TMA风险.
- 应考虑排除 CY + TT 组合的替代调节方案,以减轻 TA-TMA 的发展.
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