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基于梅尔法兰的降低强度异构血型细胞移植后的结局在功能障碍患者中

Tina Nguyen¹, Tanya Markary¹, Ni-Chun Tsai²

¹Department of Pharmacy, City of Hope National Medical Center, Duarte, California.

Transplantation and cellular therapy

|July 5, 2025

概括

患有功能障碍的患者接受血造细胞移植 (HCT) 减少强度调节 (RIC),面临更高的死亡率和毒性. 在这个人群中,测量的肌素清除比计算的估计更好地预测结果.

科学领域:

血液学血液学血液学
腎臟病學 (nephrology) 是一種醫學專業.
移植医学移植医学

背景情况:

功能障碍显著恶化了全原造血细胞移植 (HCT) 的结果.
基于梅尔法兰的低强度调节 (RIC) 已被确定为老年HCT患者的安全.
基于梅尔法兰的RIC后功能障碍对结果和毒性的特定影响需要进一步阐明.

研究的目的:

评估移植前功能如何影响fludarabine/melphalan (FM) RIC后的毒性和存活率.
为了比较测量24小时尿液肌素清除率 (UCrCl) 的预后值与计算的功能估计值.

主要方法:

对561名接受FM RIC和tacrolimus/sirolimus的HCT患者 (55-74岁) 的分析.
根据HCT前UCrCl分层的患者:<90毫升/分钟 (UCrCl 2-3) 与≥90毫升/分钟 (UCrCl 0-1).
与UCrCl与Cockcroft-Gault和CKD-EPI计算的肌素清除值进行比较.

主要成果:

较低的UCrCl (2-3) 与较高的4年非复发死亡率 (31%对19%) 和较低的整体存活率 (55%对62%) 相关联.
计算的肌素清除方法与生存终点没有相关性.
较低的UCrCl与梅尔法兰相关的不良事件增加以及较差的GVHD和胃肠毒性无生存率 (MGTFS) 有关.

结论:

基线UCrCl较差,接受基于梅尔法兰的RIC治疗的患者,患有与条件相关的毒性,GVHD和死亡率的风险增加.
在功能障碍患者中,UCrCl 是一个比计算估计的 HCT 结果更可靠的预后标记.
在这种人群中,MGTFS有效地捕捉了RIC毒性对HCT后生存的早期影响.

关键词:

移植对宿主疾病 (GVHD) 是一种移植对宿主疾病.梅尔法兰是什么意思降低强度的周围血液 HCT.功能障碍功能障碍塔克罗利木斯和西罗利木斯.

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