去除第11天甲氨蝶呤方案预防同胞相合供体造血干细胞移植后急性移植物抗宿主病  

Omission of day 11 methotrexate in methotrexate plus cyclosporine regimen for the prophylaxis of graft-versus-host disease after blood stem cell transplantation originated from human leukocyte antigen identical sibling donor

作　　者：刘慧霞[1] 邵珊 姜杰玲[1] 杨隽[1] 万理萍[1] 白海涛[1] 李肃[1] 王椿[1] 宋献民[1] LIU Huixia;SHAO Shah;JIANG Jieling;YANG Juan;WAN Liping;BAI Haitao;LI Su;WANG Chun;SONG Xianmin(Department of Hematology,Shanghai General Hospital Affiliated to Shanghai Jiao Tong University,Shanghai 200080,Chin)

机构地区：[1]上海交通大学附属第一人民医院血液科,上海200080

出　　处：《内科理论与实践》2018年第2期87-91,共5页Journal of Internal Medicine Concepts & Practice

摘　　要：目的:探讨去除第11天甲氨蝶呤(methotrexate,MTX)急性移植物抗宿主病(acute graft-versus-host disease,a GVHD)预防方案在同胞相合供体异基因外周血造血干细胞移植(allogeneic peripheral blood stem cell transplantation,allo-PBSCT)中的疗效和安全性。方法 :回顾性分析2015年1月至2017年8月接受同胞相合alloPBSCT治疗的32例患者临床资料,GVHD预防方案为环孢素(Cs A)联合MTX 15 mg/m2第1天,10 mg/m2第3、第6天。结果:中位随访时间14(7,30)个月,32例患者移植后全部造血重建。可评估患者中性粒细胞和血小板中位植入时间分别为13(11,18)d和16.5(14,36)d。a GVHD总体发生率为40.6%,Ⅱ~Ⅳ度a GVHD为25.0%。慢性GVHD(c GVHD)总体发生率为48.3%,其中轻度13.8%,中度20.7%,重度17.2%。移植后30 d内口腔黏膜炎的发生率为40.6%,Ⅲ~Ⅳ度口腔黏膜炎的发生率为18.8%。相比采用标准MTX预防方案的研究结果 ,重度口腔黏膜炎发生率显著降低(P<0.05),而a GVHD发生率差异无统计学意义。结论:去除第11天MTX预防方案相比标准4次方案,不增加Ⅱ~Ⅳ度a GVHD发生率,口腔黏膜炎发生率明显下降。Objective To evaluate the efficacy and safety of omission of day 11 methotrexate（MTX） in MTX plus cyclosporine regimen for preventing acute graft-versus-host disease（GVHD） in allogeneic peripheral blood stem cell transplantation（allo-PBSCT） originated from human leukocyte antigen（HLA）-identical sibling donor. Methods The study cohort included 32 patients who received allo-PBSCT originated from HLA identical sibling donor from January 2015 to August2017. MTX was administered at a dose of 15 mg/m2 on day1, 10 mg/m2 on day 3 and day 6 after transplantation in addition to cyclosporine. Results Hematopoietic engraftment was achieved in all patients（100%）. The median time of neutrophil and platelet engraftment were 13（11,18） d and 16.5（14,36） d, respectively, and having a median follow-up time of 14 months. Incidence of acute GVHD was 40.6%, and the incidence of grades Ⅱ-Ⅳ acute GVHD was 25.0%. The incidence of chronic GVHD was 48.3%, and the incidences of mild, moderate and severe chronic GVHD were 13.8%,20.7% and 17.2%, respectively. The incidence of oral mucositis was 40.6% and grade Ⅲ-Ⅳ was 18.8% within 30 d after transplantation. There was no statistically significant difference in incidence of acute GVHD when compared with the standard MTX and cyclosporine regimen. Conclusions Our results suggested that omission of day 11 from full dose schedule of MTX did not increase the incidence of acute GVHD, while significantly reduce the incidence of oral mucositis.

关 键 词：甲氨蝶呤 环孢素 移植物抗宿主病 口腔黏膜炎 

分 类 号：R457.2[医药卫生—治疗学]