Allo-HSCT后芦可替尼抗移植物抗宿主病与抗白血病复发的作用  

Balance of ruxolitinib to anti-GVHD and GVL effect after allo-HSCT

作　　者：党四华 刘芩 仲照东 游泳[1] 崔杰克 蒋林 沈娜 谢荣 周妹 刘文[1] 邹萍[1] Dang Sihua;Liu Qin;Zhong Zhaodong;You Yong;Cui Jieke;Jiang Lin;Shen Na;Xie Rong;Zhou Shu;Liu Wen;Zou Ping(Department of Hematology,Union Hospital,Tongji Medical Collge ,Huazhong University of Science and Technology,Wuhan 430022,China)

机构地区：[1]华中科技大学同济医学院附属协和医院血液科,武汉430022 [2]华中科技大学同济医学院附属协和医院妇产科,武汉430022

出　　处：《中华器官移植杂志》2018年第6期333-337,共5页Chinese Journal of Organ Transplantation

摘　　要：目的观察芦可替尼在造血干细胞移植后抗移植物抗宿主病(GVHD)和抗白血病复发的平衡作用及其不良反应。方法回顾性收集、分析4例造血干细胞移植后因复发而减停免疫抑制剂出现GVHD受者的临床资料,根据GVHD程度、GVHD治疗策略和疗效、疾病残留情况,给予芦可替尼治疗;依据美国国立卫生研究院(NIH)慢性GVHD评分及NIH治疗反应评估标准评价GVHD程度及疗效,依据骨髓细胞形态学、MRD、染色体、融合基因检查及外周血涂片、包块穿刺活检诊断原发病复发并评估其转归情况,依据常见不良反应事件评价标准(CTCAE)3.0版评价芦可替尼治疗的不良反应。评估周期为每月1次。结果经芦可替尼治疗后,原发病转归情况:3例基因阳性者2例全部转为阴性且随访至今持续阴性,其中1例最终出现细胞学复发,现仍存活,1例多次复发者接受治疗8个月后再次复发。GVHD缓解情况:4例受者均表现为持续部分缓解(PR)。不良反应:4例受者均未观察到明显不良反应。结论芦可替尼用于治疗HSCT后GVHD的疗效明显,在控制GVHD的过程中不影响移植物抗白血病(GVL)效应,未发生明显不良反应,体现了抗GVHD治疗和GVL效应之间的平衡。Objective To observe the anti-relapse and anti-graft versus host disease (GVHD) effects and side effects of ruxolitinib on patients who have relapsed leukemia after allo-hematopoietic stem cell transplantation (HSCT).Methods The clinical data of four patients sufferring from relapsed leukemia were collected and analyzed retrospectively.Three cases had a positive gene and 1 case had a extramedullary recurrence.All of them had serious GVHD involving multiparts,as the result of attenuating immunosuppressant aggressively.One case had central nervous system leukemia before allo-HSCT.Those patients were treated with ruxolitinib,according to the degree of GVHD,the treatment strategy and curative effect of GVHD,and the residual condition of original leukemia.Then,the degree of GVHD,the residual condition of original leukemia and the side effects of ruxolitinib were revaluated once a month after taking ruxolitinib.Results One case achieved completer remission (CR) and there partial remission (PR) in consideration of GVHD.Up to date,2 cases had no relapse in any level and 2 cases replased according to any of the results related to bone marrow aspiration.Conclusion Ruxolitinib is effective in patients with GVHD after allo-HSCT and doesn't influence GVL effect or increase the risk of relapse at the same time.Ruxolitinib doesn’t have obvious side effects when treating GVHD.

关 键 词：造血干细胞移植 芦可替尼 JAK-STAT通路 移植物抗宿主病 移植物抗白血病 

分 类 号：R733.7[医药卫生—肿瘤]