Prophylactic effect of CsA, MTX, MMF combined with ATG on GVHD in patients underwent unrelated peripheral blood hematopoietic stem cell transplantation / 中国实验血液学杂志

ABSTRACT

This study was aimed to investigate the prophylactic effect of CsA, MTX and MMF combined with ATG on graft versus host disease (GVHD) after unrelated donor peripheral blood hematopoietic stem cell transplantation (URD-PBHSCT). 33 patients underwent URD-PBHSCT with unrelated donor of HLA matched or 1 locus mismatched. The clinical data of all cases were retrospectively analyzed. URD-PBHSCT recipients received cyclosporin A+short term MTX+mycophenolate mofetil (MMF)+antithymocyte globulin to prevent GVHD (URD-ATG group), while 13 out of 33 patients were given additionally anti-CD25 antibody (URD-ATG+CD25 group). The results showed that engraftment was successfully achieved in 100% of all patients. In URD-ATG+CD25 group and URD-ATG group, the incidence of aGVHD were 23.07% and 45%, the incidence of cGVHD were 0 and 47.4% respectively. The latter was significantly higher than the former (p<0.05). The relapse rate in URD-ATG+CD25 group and URD-ATG group were 53.84% and 15% respectively, the former was significantly higher than the latter (p<0.05). The analysis on disease status of patients before transplantation displayed that the relapse rate of patients in progression status was significantly higher than that of patients in stable status (p<0.01), while the relapse rate of patients in progression status in URD-ATG+CD25 group reached to 100%. The overall survival (OS) at 1 year of patients in URD-ATG+CD25 group and URD-ATG group were 53.8% and 75% respectively, the OS at 5 years of patients in URD-ATG+CD25 group and URD-ATG group were 38.8% and 65% respectively, the OS of patients in URD-ATG group was higher than that of patients in URD-ATG+CD25 group (p<0.05). Simultaneously the OS of patients with progression status before transplantation declined obviously. It is concluded that adopting CsA+MTX+MMF+ATG as the prophylaxis of GVHD for UDR-PBSCT is effective. Reducing the dose of ATG may be good for patient in progression status.