慢性移植对宿主疾病在移植后环胺时代
Pedro Asensi Cantò1, Juan Montoro2, Aitana Balaguer-Roselló3
1Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain; cGVHD multidisciplinary committee, Hospital Universitari i Politècnic La Fe, Valencia, Spain; Instituto de Investigación Sanitaria La Fe (IISLAFE), Valencia. España. asensi_ped@gva.es.
Haematologica
|January 22, 2026
概括
慢性移植与宿主疾病 (cGVHD) 在血液细胞移植 (HCT) 后使用移植后环胺 (PTCy) 预防的22%患者中发生. 许多病例是轻微的或没有使用类固醇治疗的,但耐火性疾病需要新的治疗方法.
科学领域:
- 血液学和免疫学 血液学和免疫学
- 移植科学 移植科学
背景情况:
- 慢性移植与宿主疾病 (cGVHD) 是所有原性造血细胞移植 (HCT) 后的一个重大并发症.
- 在现代移植后循环胺 (PTCy) 预防下cGVHD的临床特征尚不清楚.
研究的目的:
- 为了前性地评估cGVHD的发病率,临床特征,治疗反应,预后因素和成年人接受HCT与基于PTCy的预防治疗的结果.
主要方法:
- 一项前性单中心研究,涉及600名成人患者,接受HCT与PTCy预防.
- 数据收集包括供体类型,cGVHD发病率,器官参与,治疗策略 (包括全身皮质类固醇) 和生存结果.
- 统计分析评估了预后因素和生存终点,如总体存活率和无cGVHD,无复发的生存率.
主要成果:
- 中度至重度cGVHD的1年累积发病率为22%,口腔是最常受影响的器官 (64%).
- 大约27%的中度至重度cGVHD病例在没有系统性皮质类固醇的情况下得到了成功的治疗.
- 一年后15%的患者需要系统治疗,与老年捐赠者 (≥30岁) 和女性对男性移植相关的风险更高;2年后的整体存活率为76%.
结论:
- 基于PTCy的预防与可管理的cGVHD发病率有关,通常不需要全身类固醇.
- 供体年龄和性别不匹配是需要全身治疗的关键风险因素,而不是供体类型.
- 尽管在许多人中使用皮质类固醇治疗是有效的,但耐火性cGVHD造成了重大负担,突出显示了对类固醇节约策略和新型干预措施的需求.
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