低剂量移植后循环胺在合一的干细胞移植:一个系统的审查
Areez Shafqat1, Omar Ahmad1, Mohammed H Omer2
1College of Medicine, Alfaisal University, Riyadh, Saudi Arabia.
Transplantation and cellular therapy
|December 5, 2025
概括
移植后的低剂量环胺 (PTCy) 在单独的干细胞移植中可以减少急性移植对宿主疾病 (GvHD),而不会影响存活率. 然而,关于慢性GvHD和毒性的证据仍然是可变的,需要进一步研究.
科学领域:
- 血液学 血液学 血液学
- 移植免疫学 移植免疫学
- 在瘤学瘤学.
背景情况:
- 对患者缺乏匹配的捐赠者来说,哈普罗特异性全基因干细胞移植 (ASCT) 非常重要.
- 移植后循环胺 (PTCy) 是一种标准的GvHD预防药物,通常是100mg/kg.
- 关于降低PTCy剂量的毒性,同时保持疗效的数据是异质的,缺乏合成.
研究的目的:
- 系统地审查是否低剂量PTCy在平分相同的ASCT中提供与标准100毫克/公斤剂量相比的或更好的结果.
- 评估急性和慢性GvHD发生率,生存率和毒性.
- 综合现有的关于在平分异性ASCT中PTCy剂量降级的数据.
主要方法:
- 按照PRISMA指导方针进行系统审查,并采用预先注册的协议 (PROSPERO).
- 从创立到2025年搜索了多个数据库,以追溯/前性研究和临床试验.
- 包括报告GvHD发病率,生存 (OS,RFS),毒性和免疫复合的研究;使用ROBINS-I和Cochrane RoB 2.0.0评估偏差风险.
主要成果:
- 包括33项研究 (31项观察性,2项RCT),涉及超过2500名患者.
- 大多数研究表明,低剂量PTCy (29-80 mg/kg) 的急性GvHD发病率较低或相似.
- 慢性GvHD的发病率没有显著差异;RCT报告了毒性,OS和RFS的相互矛盾的结果,其中一个因徒劳而停止.
结论:
- 低剂量PTCy对于急性GvHD预防可能是可比或优越的,但慢性GvHD保护是可变的.
- 关于毒性和生存的试验结果相互矛盾,加上观察性研究中的重大偏差,限制了最终的结论.
- 需要就低剂量PTCy定义和确定受益于剂量降级的患者子组达成共识.
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