基于PTCy的移植与宿主疾病预防,用于匹配的兄弟捐赠者全源造血细胞移植
Nihar Desai1,2, Majed Altareb1,2, Mats Remberger3
1Hans Messner Allogeneic Blood and Marrow Transplant Program, Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Canada.
Blood advances
|November 20, 2024
概括
移植后的环胺 (PTCy) 通过减少移植对宿主疾病 (GVHD) 和死亡率,显著改善了匹配的兄弟捐赠者血造干细胞移植 (HSCT) 的结果. 在不增加复发风险的情况下,PTCy可提高无GVHD/无复发生存率 (GRFS).
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:
- 移植后的循环胺 (PTCy) 已被确立为移植对宿主疾病 (GVHD) 预防,用于单独的和无关的捐赠者血造干细胞移植 (HSCT).
- 在匹配的兄弟捐赠者 (MSD) HSCT中PTCy的疗效仍然不太明确.
研究的目的:
- 评估PTCy对GVHD的影响,在MSD外周血液干细胞移植 (PBSC) 接受者中生存和复发.
- 为了比较基于PTCy的疗法与基于常规氨酸抑制剂 (CNI) 的预防.
主要方法:
- 对接受PBSC移植的413名MSD-HSCT患者的回顾性分析 (2010年1月 - 2023年1月).
- 根据GVHD预防方法将患者分组为:CNI + 甲甲酸盐 (MTX) / 菌酸莫菲蒂尔 (MMF),CNI + MTX/MMF + 抗血球球蛋白 (ATG),PTCy + ATG + CNI,以及PTCy + CNI + MMF.
主要成果:
- 与基于CNI的疗法相比,PTCy显著降低了急性和慢性GVHD.
- PTCy改善了无GVHD/无复发存活率 (GRFS) 和整体存活率,没有增加复发风险.
- PTCy与增加的血液感染有关;添加ATG并没有改善GRFS,但增加了细胞巨乳病毒 (CMV) 和爱斯坦-巴尔病毒 (EBV) 的重新激活.
结论:
- 在MSD-HSCT中,PTCy是一种高效的GVHD预防方法,使用PBSC移植,增强GRFS和生存率.
- 将ATG添加到PTCy疗法中对GRFS没有额外的益处,并且增加了病毒重新激活的风险.
- 建议进行进一步的前性研究和PTCy剂量优化.
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