摘要
目的:回顾性分析西罗莫司治疗激素依赖、耐药的皮肤和口腔移植物抗宿主病(GVHD)疗效。方法:观察34例激素耐药或依赖的患者。10例患者同时存在口腔和皮肤GVHD,11例患者仅表现为皮肤GVHD,13例患者仅表现为口腔GVHD;12例次在急性GVHD(aGVHD)时应用西罗莫司,28例次在慢性GVHD(cGVHD)时应用西罗莫司,其中6例患者分别在aGVHD及cGVHD时2次应用西罗莫司。结果:12例aGVHD应用西罗莫司患者总反应率为100%,在cGVHD应用西罗莫司的28例次患者中24例次均有不同程度的好转,总反应率为86%。23例次口腔GVHD患者中,12例次达到完全缓解(CR),9例次达到部分缓解(PR),总反应率达91%。在21例皮肤型GVHD患者中,10例次aGVHD中有8例次(80%)达到CR,2例次(20%)达到PR;在17例次cGVHD中有10例次达到CR,4例次达到PR,总反应率为82%。应用西罗莫司治疗的12例aGVHD患者中,有9例(75%)患者在用药后2周内出现巨细胞病毒(CMV)-DNA阳性,8例(67%)发生出血性膀胱炎。结论:西罗莫司治疗皮肤和口腔的激素耐药或依赖的GVHD疗效较好。早期应用需注意CMV血症及出血性膀胱炎的监测及预防。
Objective To analyze retrospectively the effect of the sirolimus treatment on steroid-resistant or steroid-dependent skin or oral graft versus host disease（GVHD） after allogeneic hematopoietic stem cell transplantation（allo-HSCT）.Methods Thirty-four patients with steroid-resistant or steroid-dependent GVHD were treated with sirolimus.There were 11 cases of skin GVHD,13 cases of oral GVHD and 10 cases of both skin and oral GVHD.Sirolimus was used in 12 cases of acute GVHD（aGVHD） and 28 cases of chronic GVHD（cGVHD）.Of them 6 cases were treated with sirolimus both at aGVHD and cGVHD.Results All of 12（100%） patients with aGVHD had response to sirolimus.Twenty-four of 28（86%） patients with cGVHD had response to sirolimus.Twenty one of 23（91%） patients with oral GVHD had response,including complete response（CR） in 12 cases and partial response（PR） in 9 cases.Eight of 10（80%） patients with skin aGVHD achieved CR,two（10%） patients had PR.Fourteen of 17（82%） patients with skin cGVHD had response,including CR in 10 cases and PR in 4 cases.Cytomegalovirus（CMV）-DNA positivity was detected in nine of 12（75%） patients with aGVHD treated with sirolimus within 2 weeks.Eight（67%） developed haemorrhagic cystitis.Conclusion Sirolimus is effective for treating steroid-resistant or steroid-dependent skin or oral GVHD.Prophylaxis and monitoring of CMV viremia and haemorrhagic cystitis are important in the application of sirolimus.
出处
《内科理论与实践》
2011年第1期56-59,共4页
Journal of Internal Medicine Concepts & Practice
关键词
西罗莫司
异基因造血干细胞移植
移植物抗宿主病
皮肤
口腔
Sirolimus
Allogeneic hematopoietic stem cell transplantation
Graft-versus-host disease
Skin
Oral
