期刊
ANNALS OF HEMATOLOGY
卷 100, 期 1, 页码 217-228出版社
SPRINGER
DOI: 10.1007/s00277-020-04290-1
关键词
Aplastic anemia; Cyclosporine; Tacrolimus; Anti-thymocyte globulin; GRFS
类别
资金
- Practical Research Project for Allergic Diseases and Immunology (Research Technology of Medical Transplantation) from the Japan Agency for Medical Research and Development (AMED) [18ek0510023h0002]
The study found that the choice between CSA + MTX or TAC + MTX did not significantly impact acute and chronic GVHD, OS, or GRFS. The use of ATG in conditioning reduced the risk of acute GVHD and improved GRFS in recipients of marrow from matched sibling donors.
The impact of calcineurin inhibitor types and anti-thymocyte globulin (ATG) in conditioning on overall survival (OS) and GVHD-free, relapse-free survival (GRFS) has not yet been analyzed in detail for aplastic anemia. We herein examined 517 adult patients with aplastic anemia who underwent BMT from HLA-matched sibling donors (MSD,n = 255) and unrelated donors (UD,n = 262) and were treated with cyclosporine A (CSA) + methotrexate (MTX) (n = 258) and tacrolimus (TAC) + MTX (n = 259). In total, 330 patients received ATG in conditioning. CSA + MTX versus TAC + MTX did not have a significant impact on acute and chronic GVHD, OS, or GRFS in each donor type. The use of ATG in conditioning reduced the risk of grade II-IV acute GVHD in the MSD and UD cohorts (HR 0.42,P = 0.014, and HR 0.3,P < 0.001, respectively); however, a differential impact on GRFS was identified, namely, better GRFS in MSD recipients (HR 0.56,P = 0.016), but not in UD recipients (HR 1.1,P = 0.657). In conclusion, CSA + MTX and TAC + MTX were similar as GVHD prophylaxis regardless of the donor type, and ATG in conditioning increased GRFS in MSD transplants, but not in UD transplants.
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