Posttransplant cyclophosphamide: a universal graft versus host disease prophylaxis.

IF 3.1 3区医学 Q2 HEMATOLOGY

Current Opinion in Hematology Pub Date : 2024-11-22 DOI:10.1097/MOH.0000000000000840

Andrea Bacigalupo

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引用次数: 0

Abstract

Purpose of the review: The purpose of this review is to outline current graft versus host disease (GvHD) prophylaxis, in the era of posttransplant cyclophosphamide (PTCY), in patients with malignant and nonmalignant hematologic disorders. The original combination of PTCY with a calcineurin inhibitor (CNI) and mycophenolate (MMF), reported from the Johns Hopkins University in Baltimore, was designed for patients receiving a graft from a donor mismatched at one haplotype, so called haploidentical donor (HAPLO). In the past decade, PTCY has been widely used in HAPLO transplants worldwide, confirming the amazing efficacy of PTCY in preventing GvHD in mismatched grafts.

Recent findings: More recently, PTCY is being tested also in grafts from human leukocyte antigen (HLA) identical related or unrelated donors. In the present review we will also answer several open questions, such as: PTCY and cardiac toxicity; PTCY dose; PTCY timing; PTCY and antithymocyte globulin (ATG); engraftment kinetics; infections; PTCY and leukemia relapse; PTCY and HLA identical grafts.

Summary: PTCY is currently one of the most effective measures to prevent GvHD, and can be customized in different transplant platforms, together with other immunosuppressive agents. There is place for improvement, and several possible modifications of PTCY dose and schedule can be tested in prospective trials.

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移植后环磷酰胺：一种通用的移植物抗宿主疾病预防疗法。

综述的目的：本综述旨在概述在移植后环磷酰胺（PTCY）时代，恶性和非恶性血液病患者目前的移植物抗宿主疾病（GvHD）预防措施。据巴尔的摩约翰霍普金斯大学（Johns Hopkins University）报道，最初将 PTCY 与钙神经蛋白抑制剂（CNI）和霉酚酸酯（MMF）联合使用，是为接受单倍型不匹配供体（即单倍体供体（HAPLO））移植的患者设计的。在过去的十年中，PTCY 在全世界的 HAPLO 移植中得到了广泛应用，证实了 PTCY 在预防不匹配移植物的 GvHD 方面具有惊人的疗效：最近，PTCY 也开始在人类白细胞抗原（HLA）相同或无关的供体的移植物中进行测试。在本综述中，我们还将回答几个悬而未决的问题，如：PTCY 和心脏毒性：摘要：PTCY 是目前预防 GvHD 最有效的措施之一，可与其他免疫抑制剂一起用于不同的移植平台。但仍有改进的余地，可在前瞻性试验中对 PTCY 的剂量和时间安排进行几种可能的修改。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Current Opinion in Hematology 医学-血液学

CiteScore

6.60

自引率

3.10%

发文量

审稿时长

6-12 weeks

期刊介绍： Current Opinion in Hematology is an easy-to-digest bimonthly journal covering the most interesting and important advances in the field of hematology. Its hand-picked selection of editors ensure the highest quality selection of unbiased review articles on themes from nine key subject areas, including myeloid biology, Vascular biology, hematopoiesis and erythroid system and its diseases.