Ann Hematol:环磷酰胺单倍体造血细胞移植后不良结果的危险因素:一项两中心分析

2022-05-20 网络 网络

他克莫司对 II-IV 级 aGVHD 和 cGVHD 均有保护作用,这表明他克莫司在预防 GVHD 方面可能比环孢素更有效。PBSC 是 cGVHD 的危险因素,对复发没有任何影响。

同种异体造血细胞移植 (HCT) 是几种恶性血液病的潜在治愈性疗法,包括半相合供体在内的替代供体在 HCT 中发挥重要作用。尽管 haplo-HCT 与移植后环磷酰胺(PTCy)的使用越来越多,但仍有一些问题悬而未决。本研究的目的是调查 haplo-HCT 与 PTCy 后不良结果的危险因素。这是在两个巴西中心进行的回顾性研究。

研究共纳入 103 名接受首次同种异体、半相合 HCT 和 PTCy 的血液系统恶性肿瘤患者。死亡的危险因素是移植年龄(每年 HR = 1.03;p = 0.002)和高/非常高的疾病风险指数(DRI;HR = 2.77;p = 0.0007)和母亲作为供体与其他供体相比(HR = 3.53;p = 0.005)。

表:多变量分析:由于III-IV级急性(移值物抗宿主疾病)GVHD(7)的事件数较少,我们没有进行多变量分析DRI、疾病风险指数;GVHD,移植物抗宿主病

图1:图1总生存期

图2:无进展生存率,按性别匹配标准划分

在多变量分析中,与其他供体相比,老年患者 (HR = 1.02; p = 0.006)、高/非常高 DRI (HR = 2.39; p = 0.003) 和母亲作为供体 (HR = 3.18; p = 0.006) 的 PFS 明显较差. 与其他捐赠者相比,高/非常高 DRI (HR = 4.01; p = 0.002) 和母亲作为捐赠者的复发率更高 (HR = 2.52; p = 0.05)。老年患者的 NRM 较高(每年 HR = 1.03;p = 0.03)。

图3:II-IV级急性GVHD,按移植物类型划分

图4:慢性GVHD,按移植物类型划分

与环孢素相比,他克莫司是 II-IV 级 aGVHD(HR = 0.46;p = 0.04)的保护因素。外周血 (PBSC) 是移值物抗宿主疾病( cGVHD) 的危险因素(HR = 3.48;p = 0.006),而他克莫司具有保护作用(HR = 0.30;p = 0.009)。与其他捐赠者相比,母亲作为捐赠者也是 OS、PFS 和复发较差的风险因素,这表明应避免这种组合。

他克莫司对 II-IV 级 aGVHD 和 cGVHD 均有保护作用,这表明他克莫司在预防 GVHD 方面可能比环孢素更有效。PBSC 是 cGVHD 的危险因素,对复发没有任何影响。目前尚在等待比较他克莫司与环孢素的前瞻性研究结果。

 

原始出处:

de Lima VJT, da Silva AF, Kerbauy LN, Kerbauy MN, Lerner D, Colares M, Ribeiro AAF, da Silva CF, Hamerschlak N, Arcuri LJ. Risk factors for adverse outcomes following haploidentical hematopoietic cell transplantation with posttransplant cyclophosphamide: a two-center analysis. Ann Hematol. 2022 May 16. doi: 10.1007/s00277-022-04865-0. Epub ahead of print. PMID: 35575911.

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    2022-05-20 fengyi812
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    2022-05-20 俅侠
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