他克莫司与环孢素 a 联合移植后环磷酰胺治疗 AML 首次完全缓解：急性白血病工作组 (EBMT) 的一项研究。
Tacrolimus versus cyclosporine a combined with post-transplantation cyclophosphamide for AML In first complete remission: a study from the acute leukemia working party (EBMT).
发表日期：2024 Jul 03
作者：
Gesine Bug, Myriam Labopin, Alexander Kulagin, Didier Blaise, Anna Maria Raiola, Jan Vydra, Simona Sica, Mi Kwon, Lucía López-Corral, Stefania Bramanti, Peter von dem Borne, Maija Itälä-Remes, Massimo Martino, Yener Koc, Eolia Brissot, Sebastian Giebel, Arnon Nagler, Fabio Ciceri, Mohamad Mohty
来源：
Stem Cell Research & Therapy
摘要：
钙调神经磷酸酶抑制剂的选择可能会影响接受移植后环磷酰胺 (PT-Cy) 和吗替麦考酚酯 (MMF) 的 T 细胞充足造血细胞移植 (HCT) 患者的结果，以预防移植物抗宿主病 (GVHD)。我们回顾性分析了 2427 名首次缓解的急性髓系白血病 (AML) 患者，这些患者使用环孢素 A（CSA，63%）或他克莫司（TAC，37%）从半相合供体（n = 1844）或无关供体（UD，n = 583）移植）和 PT-Cy/MMF。在单变量分析中，CSA 和 TAC 组在 2 年无白血病生存率或总生存率、复发累积发生率 (CI) 或非复发死亡率方面没有差异。 TAC 治疗时严重 III-IV 级急性 GVHD 的 CI 较低（6.6% vs. 9.1%，p = 0.02），II-IV 级急性 GVHD 或 III-IV 级急性 GVHD/严重慢性 GVHD 没有差异，无复发生存率（GRFS）。在多变量分析中，TAC 与仅半相合供者发生严重 III-IV 级急性 GVHD 的较低风险相关（HR 0.64 [95% CI，0.42-0.98]，p = 0.04），但与 UD 无关（HR 0.49 [95% CI]） CI，0.2-1.21]，p = 0.12）。慢性 GVHD 没有显着差异。总之，无论添加多少 CNI，基于 PT-Cy/MMF 的 GVHD 预防都能获得良好的 OS 和 GRFS。在半相合 HCT 中，TAC 似乎比 CSA 更有效地预防严重急性 GVHD，且不影响其他结果参数。© 2024。作者。
Choice of calcineurin inhibitor may impact the outcome of patients undergoing T-cell replete hematopoietic cell transplantation (HCT) with post-transplant cyclophosphamide (PT-Cy) and mycophenolate mofetil (MMF) for prophylaxis of graft-versus-host disease (GVHD). We retrospectively analyzed 2427 patients with acute myeloid leukemia (AML) in first remission transplanted from a haploidentical (n = 1844) or unrelated donor (UD, n = 583) using cyclosporine A (CSA, 63%) or tacrolimus (TAC, 37%) and PT-Cy/MMF. In univariate analysis, CSA and TAC groups did not differ in 2-year leukemia-free or overall survival, cumulative incidence (CI) of relapse or non-relapse mortality. CI of severe grade III-IV acute GVHD was lower with TAC (6.6% vs. 9.1%, p = 0.02), without difference in grade II-IV acute GVHD or grade III-IV acute GVHD/severe chronic GVHD, relapse-free survival (GRFS). In multivariate analysis, TAC was associated with a lower risk of severe grade III-IV acute GVHD solely with haploidentical donors (HR 0.64 [95% CI, 0.42-0.98], p = 0.04), but not UD (HR 0.49 [95% CI, 0.2-1.21], p = 0.12). There was no significant difference for chronic GVHD. In conclusion, PT-Cy/MMF-based GVHD prophylaxis resulted in favorable OS and GRFS, irrespective of the CNI added. In haploidentical HCT, TAC seemed to prevent severe acute GVHD more effectively than CSA without impact on other outcome parameters.© 2024. The Author(s).