期刊
BONE MARROW TRANSPLANTATION
卷 39, 期 1, 页码 31-39出版社
NATURE PUBLISHING GROUP
DOI: 10.1038/sj.bmt.1705539
关键词
graft-versus-host disease; engraftment syndrome; pre-engraftment immune reaction; allogeneic hematopoietic stem cell transplantation; non-myeloablative stem cell transplantation
Post transplant immune disorders are problematic in cord blood transplantation (CBT) for adult patients, and optimal prophylaxis has not been established. We investigated whether intensive graft-versus-host disease (GVHD) prophylaxis using short-term methotrexate (MTX) has a prognostic impact on CBT. Post-CBT immune reactions were classified according to time course as pre-engraftment immune reaction (PIR), engraftment syndrome (ES) or acute GVHD. Between March 2001 and November 2005, a total of 77 patients underwent CBT at eight transplantation centers. Median age was 48 years ( range, 18 - 69 years). Preparative regimens comprised myeloablative (n = 31) or reduced-intensity ( n 46). Acute GVHD prophylaxis included cyclosporine alone ( n 23), tacrolimus alone ( n 12), cyclosporine plus MTX ( n 17), tacrolimus plus short-term MTX ( n 23) or cyclosporine plus methylprednisolone ( n 2). Cumulative incidences of PIR, ES and grade II - IV GVHD were 36, 12 and 23%, respectively. Short-term MTX exerted significant favorable effects on post-CBT immune reactions ( hazard ratio, 0.55; 95% confidence interval ( 95% CI), 0.31 - 0.98; P = 0.04) in multivariate analysis. Overall survival rates for patients with and without short-term MTX at day 180 were 59% ( 95% CI, 42 - 73%) and 16% ( 95% CI, 6.6 - 30%) ( P = 0.0001), respectively. Short-term MTX could offer one optimal regimen to reduce immune reactions and improve outcomes in CBT.
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