异基因造血细胞移植(alloHSCT)是急性白血病和许多其他血液系统恶性肿瘤的标准治疗方法。正确选择适用于不同类型移植的免疫抑制剂仍然需要严格和仔细的考虑,这方面的数据是不同的。出于这个原因,在这个单一的中心,回顾性研究,我们的目的是比较接受移植后环磷酰胺(PTCy)治疗MMUD和单用haplo-HSCT或GvHD预防治疗MMUD-HSCT的145例患者的结局.我们试图验证PTCy是否是MMUD设置中的最佳策略。93例(93/145;64.1%)接受了单倍型HSCT,52例(52/145;35.9%)接受了MMUD-HSCT。有110例患者接受PTCy(93在单倍形组,17在MMUD组)和35例患者接受基于抗胸腺细胞球蛋白(ATG)的常规GvHD预防,环孢菌素(CsA),仅在MMUD组中使用甲氨蝶呤(Mtx)。我们的研究表明,与CsAMtxATG组相比,接受移植后环磷酰胺(PTCy)的患者显示出急性GvHD率和CMV再激活率降低,以及抗病毒治疗前后CMV拷贝数的统计学降低。考虑到慢性GvHD,主要预测因素是捐赠者年龄,≥40年,和haplo-HSCT管理。此外,与接受CsA+Mtx+ATG的患者相比,接受MMUD-HSCT并接受他克莫司和霉酚酸酯PTCy的患者的生存率高8倍以上(OR=8.31,p=0.003).这些数据加在一起表明,无论进行的移植类型如何,与ATG相比,使用PTCy在存活率方面显示出更多的益处。然而,需要更多样本量较大的研究来确认文献研究中相互矛盾的结果.
Allogeneic hematopoietic cell transplantation (alloHSCT) is a standard therapeutic approach for acute leukemias and many other hematologic malignancies. The proper choice of immunosuppressants applicable to different types of transplantations still requires strict and careful consideration, and data in this regard are divergent. For this reason, in this single-centered, retrospective study, we aimed to compare the outcome of 145 patients who received post-transplant cyclophosphamide (PTCy) for MMUD and haplo-HSCT or GvHD prophylaxis for MMUD-HSCT alone. We attempted to verify if PTCy is an optimal strategy in MMUD setting. Ninety-three recipients (93/145; 64.1%) underwent haplo-HSCT while 52 (52/145; 35.9%) underwent MMUD-HSCT. There were 110 patients who received PTCy (93 in haplo and 17 in MMUD group) and 35 patients received conventional GvHD prophylaxis based on antithymocyte globulin (ATG), cyclosporine (CsA), and methotrexate (Mtx) in the MMUD group only. Our study revealed that patients receiving post-transplant cyclophosphamide (PTCy) show decreased acute GvHD rates and CMV reactivation as well as a statistically lower number of CMV copies before and after antiviral treatment compared to the CsA + Mtx + ATG group. Taking into account chronic GvHD, the main predictors are donor age, ≥40 years, and haplo-HSCT administration. Furthermore, the survival rate of patients following MMUD-HSCT and receiving PTCy with tacrolimus and mycophenolate mofetil was more than eight times greater in comparison to patients receiving CsA + Mtx + ATG (OR = 8.31, p = 0.003). These data taken together suggest that the use of PTCy displays more benefits in terms of survival rate compared to ATG regardless of the type of transplantation performed. Nevertheless, more studies with a larger sample size are required to confirm the conflicting results in the literature studies.