不同环孢素应用方式对重型再生障碍性贫血患者异基因造血干细胞移植急性移植物抗宿主病的影响分析  

Effect of different cyclosporine application regimens on acute graft versus host disease in allogeneic hematopoietic stem cell transplantation in patients with severe aplastic anemia

作　　者：郭伟[1] 赵雅倩 马梁明[1] 王涛[1] Guo Wei;Zhao Yaqian;Ma Liangming;Wang Tao(Department of Hemopathology,Third Hospital of Shanxi Medical University,Shanxi Bethune Hospital,Shanxi Academy of Medical Sciences,Tongji Shanxi Hospital,Taiyuan,Shanxi 030032,China)

机构地区：[1]山西医科大学第三医院、山西白求恩医院(山西医学科学院)同济山西医院血液内科,山西太原030032

出　　处：《中国医学前沿杂志(电子版)》2025年第1期64-71,共8页Chinese Journal of the Frontiers of Medical Science(Electronic Version)

基　　金：山西省自然科学基金面上项目(202203021211070)。

摘　　要：目的分析不同环孢素(cyclosporin A,CsA)应用方式对重型再生障碍性贫血(severe aplastic anaemia,SAA)患者异基因造血干细胞移植(allogeneic hematopoietic stem cell transplantation,allo-HSCT)后急性移植物抗宿主病(acute graft versus host disease,aGVHD)的疗效影响。方法回顾分析2012年1月至2023年12月在山西白求恩医院接受allo-HSCT的63例SAA患者,所有患者均在allo-HSCT后使用CsA预防aGVHD,25例接受传统CsA预防的患者为T1组(移植后患者的胃肠功能恢复正常后,CsA静脉注射改为口服应用),38例接受延迟口服CsA静脉注射方案的患者为T2组(连续静脉注射CsA直至+50 d,然后改为口服CsA方案)。分析不同CsA应用方式后aGVHD的发生率、CsA导致的药物不良反应、出现aGVHD的危险因素、CsA平均浓度、总生存期的差异。结果两组间Ⅱ~Ⅳ级aGVHD的发生率差异有统计学意义(T1组比T2组:64.0%比36.8%,P=0.032)。对于人类白细胞抗原不全相合供者(human leukocyte antigen-mismatched-related donor,HLA-MMRD)移植,Ⅱ~Ⅳ级aGVHD的发生率差异有统计学意义(T1组比T2组:56.0%比18.4%,P=0.001)。T1方案和HLA-MMRD是发生Ⅱ~Ⅳ级aGVHD的重要独立危险因素。两组之间的总生存率差异有统计学意义(T1组比T2组:68.9%比89.5%,HR=2.526,95%CI:1.131~5.638,P=0.039)。结论延迟口服CsA方案可能是降低SAA患者aGVHD发生率的有效方式。Objective To analyze the therapeutic effects of different cyclosporine application regimens on acute graft versus host disease(aGVHD)after allogeneic hematopoietic stem cell transplantation(allo-HSCT)in patients with severe aplastic anaemia(SAA).Methods A retrospective analysis of 63 SAA patients who underwent allo-HSCT from January 2012 to December 2023 at Shanxi Bethune Hospital,all of whom used cyclosporin A(CsA)to prevent aGVHD after allo-HSCT.Twenty-five patients receiving conventional cyclosporine prophylaxis were in the T1 group(intravenous cyclosporine was switched to oral administration after the patient's gastrointestinal function returned to normal after transplantation),and 38 patients who received a delayed intravenous cyclosporine regimen were in the T2 group(continuous intravenous cyclosporine until+50 d,then switched to oral cyclosporine regimen).The incidence of aGVHD,adverse drug reactions caused by CsA,risk factors for aGVHD,mean concentration of CsA,and overall survival time were analyzed.Results There was a significant difference in the incidence of grade II-IV aGVHD between the two groups(T1 vs.T2:64.0%vs.36.8%,P=0.032).Among patients with HLA-mismatched-related donor(HLA-MMRD)transplants,the incidence of gradeⅡ-ⅣaGVHD was also significantly different(T1 vs.T2:56.0%vs.18.4%,P=0.001).T1 regimen and HLAMMRD were important independent risk factors for the incidence of grade II-IV aGVHD.The overall survival time between the two groups was significantly different(T1 vs.T2:68.9%vs.89.5%,HR=2.526,95%CI 1.131-5.638,P=0.039).Conclusions Delayed oral cyclosporine regimen may be an effective method to reduce the incidence of aGVHD in SAA patients.

关 键 词：环孢素 急性移植物抗宿主病 重度再生障碍性贫血 异基因干细胞移植 

分 类 号：R55[医药卫生—血液循环系统疾病]