{"title":"匹配供体干细胞移植中的移植物抗宿主疾病预防：移植后环磷酰胺联合用药与甲氨蝶呤/他克莫司联合用药。","authors":"","doi":"10.1016/j.transproceed.2024.08.004","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><p>The use of post-transplant cyclophosphamide (PTCy) is highly effective in preventing graft versus host disease (GVHD) for haploidentical allogeneic hematopoietic stem cell transplantation (allo-HSCT). There is limited data on the role of PTCy as GVHD prophylaxis in matched-sibling and fully matched-unrelated donor (MSD/MUD) allo-HSCT.</p></div><div><h3>Methods</h3><p>Our single-center retrospective study aims to compare outcomes of PTCy alone or in combination with mycophenolate mofetil and tacrolimus (PTCy/MMF/TAC) relative to methotrexate and tacrolimus (MTX/TAC). The primary endpoint of our study was GVHD-free, relapse free survival (GRFS). Secondary endpoints were overall survival (OS), disease free survival (DFS), and incidence of severe acute and chronic GVHD. We identified 74 adult patients who underwent MSD/MUD allo-HSCT at our institution from 2015 to 2023.</p></div><div><h3>Results</h3><p>Within our cohort, 33.8% (<em>n</em> = 25) received MTX/TAC, while 54.0% (<em>n</em> = 40) received PTCy/MMF/TAC, and 12.2% (<em>n</em> = 9) received PTCy alone. Patients receiving PTCY had the longest time to neutrophil engraftment relative to MTX/TAC (15 days vs. 12 days, <em>P</em> = .010). PTCy/MMF/TAC was associated with improved GRFS relative to MTX/TAC (hazard ratio [HR] = HR 0.42, 95% CI 0.19-0.93, <em>P</em> = .031), which persisted when controlling for age. Incidence of chronic GVHD was lower in the PTCy/MMF/TAC group compared to MTX/TAC (1-year 9.0% vs. 30.1%, HR 0.19, 95% CI 0.06-0.59, <em>P</em> = .005). However, OS and DFS were comparable across all groups.</p></div><div><h3>Conclusions</h3><p>Our results demonstrate decreased rates of severe chronic GVHD resulting in improved GRFS when using PTCy/TAC/MTX as GVHD prophylaxis compared to MTX/TAC in MSD/MUD.</p></div>","PeriodicalId":23246,"journal":{"name":"Transplantation proceedings","volume":null,"pages":null},"PeriodicalIF":0.8000,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Graft Versus Host Disease Prophylaxis in Matched Donor Stem Cell Transplantation: Post-transplantation Cyclophosphamide Combinations Versus Methotrexate/Tacrolimus\",\"authors\":\"\",\"doi\":\"10.1016/j.transproceed.2024.08.004\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><p>The use of post-transplant cyclophosphamide (PTCy) is highly effective in preventing graft versus host disease (GVHD) for haploidentical allogeneic hematopoietic stem cell transplantation (allo-HSCT). There is limited data on the role of PTCy as GVHD prophylaxis in matched-sibling and fully matched-unrelated donor (MSD/MUD) allo-HSCT.</p></div><div><h3>Methods</h3><p>Our single-center retrospective study aims to compare outcomes of PTCy alone or in combination with mycophenolate mofetil and tacrolimus (PTCy/MMF/TAC) relative to methotrexate and tacrolimus (MTX/TAC). The primary endpoint of our study was GVHD-free, relapse free survival (GRFS). Secondary endpoints were overall survival (OS), disease free survival (DFS), and incidence of severe acute and chronic GVHD. We identified 74 adult patients who underwent MSD/MUD allo-HSCT at our institution from 2015 to 2023.</p></div><div><h3>Results</h3><p>Within our cohort, 33.8% (<em>n</em> = 25) received MTX/TAC, while 54.0% (<em>n</em> = 40) received PTCy/MMF/TAC, and 12.2% (<em>n</em> = 9) received PTCy alone. Patients receiving PTCY had the longest time to neutrophil engraftment relative to MTX/TAC (15 days vs. 12 days, <em>P</em> = .010). PTCy/MMF/TAC was associated with improved GRFS relative to MTX/TAC (hazard ratio [HR] = HR 0.42, 95% CI 0.19-0.93, <em>P</em> = .031), which persisted when controlling for age. Incidence of chronic GVHD was lower in the PTCy/MMF/TAC group compared to MTX/TAC (1-year 9.0% vs. 30.1%, HR 0.19, 95% CI 0.06-0.59, <em>P</em> = .005). However, OS and DFS were comparable across all groups.</p></div><div><h3>Conclusions</h3><p>Our results demonstrate decreased rates of severe chronic GVHD resulting in improved GRFS when using PTCy/TAC/MTX as GVHD prophylaxis compared to MTX/TAC in MSD/MUD.</p></div>\",\"PeriodicalId\":23246,\"journal\":{\"name\":\"Transplantation proceedings\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":0.8000,\"publicationDate\":\"2024-09-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Transplantation proceedings\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S0041134524004329\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q4\",\"JCRName\":\"IMMUNOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Transplantation proceedings","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0041134524004329","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"IMMUNOLOGY","Score":null,"Total":0}
引用次数: 0
摘要
背景：在单倍体同种异体造血干细胞移植（allo-HSCT）中，移植后使用环磷酰胺（PTCy）可有效预防移植物抗宿主疾病（GVHD）。关于PTCy在配对同胞和完全配对非亲缘供体（MSD/MUD）异体造血干细胞移植中预防移植物抗宿主疾病作用的数据有限：我们的单中心回顾性研究旨在比较 PTCy 单独使用或与霉酚酸酯和他克莫司联合使用（PTCy/MMF/TAC）与甲氨蝶呤和他克莫司联合使用（MTX/TAC）的疗效。我们研究的主要终点是无GVHD、无复发生存期（GRFS）。次要终点是总生存期（OS）、无病生存期（DFS）以及严重急性和慢性 GVHD 的发生率。我们确定了2015年至2023年期间在本院接受MSD/MUD allo-HSCT的74名成年患者：在我们的队列中，33.8%（n = 25）接受了MTX/TAC，54.0%（n = 40）接受了PTCy/MMF/TAC，12.2%（n = 9）仅接受了PTCy。与 MTX/TAC 相比，接受 PTCY 的患者中性粒细胞移植时间最长（15 天 vs. 12 天，P = 0.010）。相对于MTX/TAC，PTCy/MMF/TAC与GRFS的改善相关（危险比[HR] = HR 0.42，95% CI 0.19-0.93，P = .031），在控制年龄后，这一结果依然存在。与MTX/TAC相比，PTCy/MMF/TAC组的慢性GVHD发生率较低（1年9.0% vs. 30.1%，HR 0.19，95% CI 0.06-0.59，P = .005）。然而，各组的OS和DFS相当：我们的研究结果表明，与MTX/TAC相比，在MSD/MUD患者中使用PTCy/TAC/MTX作为GVHD预防药物可降低严重慢性GVHD的发生率，从而改善GRFS。
Graft Versus Host Disease Prophylaxis in Matched Donor Stem Cell Transplantation: Post-transplantation Cyclophosphamide Combinations Versus Methotrexate/Tacrolimus
Background
The use of post-transplant cyclophosphamide (PTCy) is highly effective in preventing graft versus host disease (GVHD) for haploidentical allogeneic hematopoietic stem cell transplantation (allo-HSCT). There is limited data on the role of PTCy as GVHD prophylaxis in matched-sibling and fully matched-unrelated donor (MSD/MUD) allo-HSCT.
Methods
Our single-center retrospective study aims to compare outcomes of PTCy alone or in combination with mycophenolate mofetil and tacrolimus (PTCy/MMF/TAC) relative to methotrexate and tacrolimus (MTX/TAC). The primary endpoint of our study was GVHD-free, relapse free survival (GRFS). Secondary endpoints were overall survival (OS), disease free survival (DFS), and incidence of severe acute and chronic GVHD. We identified 74 adult patients who underwent MSD/MUD allo-HSCT at our institution from 2015 to 2023.
Results
Within our cohort, 33.8% (n = 25) received MTX/TAC, while 54.0% (n = 40) received PTCy/MMF/TAC, and 12.2% (n = 9) received PTCy alone. Patients receiving PTCY had the longest time to neutrophil engraftment relative to MTX/TAC (15 days vs. 12 days, P = .010). PTCy/MMF/TAC was associated with improved GRFS relative to MTX/TAC (hazard ratio [HR] = HR 0.42, 95% CI 0.19-0.93, P = .031), which persisted when controlling for age. Incidence of chronic GVHD was lower in the PTCy/MMF/TAC group compared to MTX/TAC (1-year 9.0% vs. 30.1%, HR 0.19, 95% CI 0.06-0.59, P = .005). However, OS and DFS were comparable across all groups.
Conclusions
Our results demonstrate decreased rates of severe chronic GVHD resulting in improved GRFS when using PTCy/TAC/MTX as GVHD prophylaxis compared to MTX/TAC in MSD/MUD.
期刊介绍：
Transplantation Proceedings publishes several different categories of manuscripts, all of which undergo extensive peer review by recognized authorities in the field prior to their acceptance for publication.
The first type of manuscripts consists of sets of papers providing an in-depth expression of the current state of the art in various rapidly developing components of world transplantation biology and medicine. These manuscripts emanate from congresses of the affiliated transplantation societies, from Symposia sponsored by the Societies, as well as special Conferences and Workshops covering related topics.
Transplantation Proceedings also publishes several special sections including publication of Clinical Transplantation Proceedings, being rapid original contributions of preclinical and clinical experiences. These manuscripts undergo review by members of the Editorial Board.
Original basic or clinical science articles, clinical trials and case studies can be submitted to the journal?s open access companion title Transplantation Reports.
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