移植与宿主疾病预防在匹配的捐赠者干细胞移植中:移植后的环胺组合与甲索特/塔克罗利斯相比
Karam Ashouri1, Eduardo Fernandez2, Anush Ginosyan1
1Keck School of Medicine of USC, Los Angeles, California.
Transplantation proceedings
|August 22, 2024
概括
移植后的环胺 (PTCy) 与其他免疫抑制剂一起,在匹配的兄弟姐妹/非相关的捐赠者移植中改善了无GVHD,无复发的生存率. 这种方法也显著降低了慢性移植与宿主疾病的发生率.
科学领域:
- 造血干细胞移植 造血干细胞移植
- 免疫学 免疫学 免疫学
- 在瘤学瘤学.
背景情况:
- 移植后循环胺 (PTCy) 是一种经过验证的策略,用于预防移植对宿主疾病 (GVHD) 在单独异性的全原血造干细胞移植 (allo-HSCT) 中.
- 关于PTCy在匹配的兄弟姐妹和完全匹配的非相关捐赠者 (MSD/MUD) allo-HSCT中对GVHD预防的疗效的数据有限.
研究的目的:
- 为了比较基于PTCy的GVHD预防疗法的疗效与MSD/MUD allo-HSCT中的传统甲醇和塔克罗利 (MTX/TAC) 相比.
- 评估PTCy对无GVHD,无复发生存期 (GRFS),总生存期 (OS),无疾病生存期 (DFS) 和GVHD发病率的影响.
主要方法:
- 2015年至2023年期间,对74名接受MSD/MUD allo-HSCT治疗的成年患者进行了单中心回顾性研究.
- 患者接受了MTX/TAC,单独接受PTCy或PTCy与mycophenolate mofetil和tacrolimus (PTCy/MMF/TAC) 联合治疗.
- 主要终点是GRFS;次要终点包括OS,DFS和GVHD发病率.
主要成果:
- 与MTX/TAC (15对12天,P=0.010) 相比,接受基于PTCy的治疗方案的患者经历了中性粒细胞移植的延迟.
- 与MTX/TAC相比,PTCy/MMF/TAC显著改善了GRFS (HR 0.42,P = .031),这种效应在年龄调整后持续存在.
- PTCy/MMF/TAC组显示慢性GVHD的发病率较低 (1年9.0%对30.1%,HR 0.19,P = .005),而OS和DFS在各组中相似.
结论:
- 与MMF和TAC (PTCy/MMF/TAC) 结合使用PTCy可以增强MSD/MUD allo-HSCT中的GRFS.
- 与标准MTX/TAC预防相比,这种基于PTCy的疗法显著降低了严重慢性GVHD的发生率.
- 在MSD/MUD allo-HSCT中,PTCy代表了GVHD预防的有希望的替代方案,改善了关键的生存结果.
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