摘要
目的观察芦可替尼联合糖皮质激素一线治疗急性移植物抗宿主病(GVHD)对巨细胞病毒(CMV)激活的影响。方法回顾性分析2018年8月至2020年9月期间195例在解放军总医院第一医学中心血液病科进行异基因造血干细胞移植患者的临床资料, 根据急性GVHD发生情况分为无、Ⅰ度、Ⅱ~Ⅳ度、Ⅲ/Ⅳ度急性GVHD组, 根据急性GVHD一线治疗方案分为联合方案组(芦可替尼联合糖皮质激素)及经典方案组(单用糖皮质激素)。分析移植后90 d及180 d各组CMV激活累积发生率、CMV激活时长及转阴时长, 比较联合方案组及经典方案组总生存率及无病生存率。结果 195例患者中无急性GVHD 64例(32.8%)、Ⅰ度急性GVHD 30例(15.4%)、Ⅱ~Ⅳ度急性GVHD 101例(51.8%)、Ⅲ/Ⅳ度急性GVHD 14例(7.2%)。联合方案组、经典方案组Ⅰ~Ⅳ度急性GVHD患者在移植后90 d及180 d CMV激活累积发生率差异无统计学意义(P值均>0.05), 且CMV激活时长及转阴时长差异也无统计学意义(P值均>0.05)。进一步对两种方案一线治疗Ⅱ~Ⅳ度及Ⅲ/Ⅳ度急性GVHD进行分析, 发现在移植后90 d及180 d CMV激活累积发生率、激活时长及转阴时长差异均无统计学意义(P值均>0.05)。此外, 两组急性GVHD患者移植后2年总生存率及无病生存率差异均无统计学意义(P值均>0.05)。结论芦可替尼联合糖皮质激素一线治疗急性GVHD不增加CMV激活的风险。
Objective To observe the effect of ruxolitinib combined with glucocorticoid on cytomegalovirus(CMV)activation in patients with acute graft-versus-host disease(aGVHD).Methods The clinical data of 195 patients who underwent allogeneic hematopoietic stem cell transplantation in the Department of Hematology of the First Medical Center of the People’s Liberation Army General Hospital from August 2018 to September 2020 were retrospectively analyzed.According to the severity of aGVHD,the patients were divided into the non-GVHD group,aGVHD gradeⅠgroup,aGVHD gradeⅡ-Ⅳgroup,and aGVHD gradeⅢ/Ⅳgroup.In addition,they were classified into two subgroups according to the first-line treatment regimen for aGVHD:combined regimen group(ruxolitinib combined with glucocorticoid)and classical regimen group(glucocorticoid alone).The cumulative incidence of CMV activation,the duration of CMV activation,and the duration of CMV negativity in each subgroup at 90 and 180 days after transplantation were analyzed.The overall survival and disease-free survival rates of patients in both regimens were compared.Results Sixty-four(32.8%)patients in the group did not develop aGVHD.The numbers of patients with gradeⅠ,Ⅱ-Ⅳ,andⅢ/ⅣaGVHD were 30(15.4%),101(51.8%),and 14(7.2%),respectively.Compared with patients in the classical regimen,no significant difference was observed in the cumulative incidence of CMV activation,duration of CMV activation,and duration of CMV negativity in patients with gradeⅠ-ⅣaGVHD in the combined regimen at 90 and 180 days after transplantation(P>0.05).Further analysis of patients with gradeⅡ-ⅣandⅢ/ⅣaGVHD showed that the cumulative incidence of CMV activation,duration of CMV activation,and duration of CMV negativity did not show significant difference between the two treatment regimens(P>0.05).In addition,there was no significant difference in the overall survival and disease-free survival rates of patients in both regimens(P>0.05).Conclusion Ruxolitinib combined with glucocorticoid as the first-l
作者
邢双义
钱坤
赵英欣
彭博
杨晶晶
窦立萍
刘代红
Xing Shuangyi;Qian Kun;Zhao Yingxin;Peng Bo;Yang Jingjing;Dou Liping;Liu Daihong(Medical School of Chinese PLA,Chinese PLA General Hospital,Department of Hematology in the Fifth Medical Center of PLA General Hospital,Beijing 100853,China)
出处
《中华血液学杂志》
CAS
CSCD
北大核心
2022年第9期732-737,共6页
Chinese Journal of Hematology
基金
国家自然科学基金(82070178、81770203、81700122、81270610)
军队卫勤保障能力创新与生成专项(21WQ034)
解放军总医院转化项目(ZH19003)
解放军总医院医疗大数据与人工智能研发项目(2019MBD-016、2019MBD-008)
保健专项科研课题(21BJZ30)。
关键词
异基因造血干细胞移植
急性移植物抗宿主病
芦可替尼
巨细胞病毒
Allogeneic hematopoietic stem cell transplantation
Acute graft-versus-host disease
Ruxolitinib
Cytomegalovirus
