干扰素γ释放试验具有预测清髓异基因造血干细胞移植后以环磷酰胺为基础的移植物抗宿主病预防的慢性移植物抗宿主病的潜力。

IF 1.6 4区医学 Q4 IMMUNOLOGY

Transplant immunology Pub Date : 2025-02-01 DOI:10.1016/j.trim.2024.102166

Markéta Šťastná-Marková , Pavla Pecherková , Šárka Němečková , Jitka Kryštofová , Šárka Vaníková , Jan Vydra , Kateřina Roubalová

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引用次数: 0

摘要

背景：同种异体造血干细胞移植（allogene异体造血干细胞移植）后的免疫重建率在严重移植后并发症的发生中起主要作用。然而，移植后的过程本身对受体免疫系统的形成有重大影响，因此代表了随后不利结果的危险因素。干扰素γ (IFNγ)释放试验（IGRA）对移植后接受环磷酰胺治疗的同种异体造血干细胞移植患者移植物抗宿主病（GVHD）或血液学复发的预测能力以及这些并发症对细胞免疫反应性恢复的影响进行了评估。研究设计：一项前瞻性观察性研究，纳入了62例髓系恶性血液病成人患者，他们接受了同种异体造血干细胞移植，并采用清髓调节方案联合移植后环磷酰胺。收集临床数据，并在调节方案开始前和alloo - hsct后12 个月进行IGRA。采用多元Cox回归和logistic回归模型进行逐步回归分析，计算急性或慢性GVHD或血液学复发的预测值。结果：移植前和移植后早期IGRA值和其他选定的协变量（年龄、诊断、复发风险、调节类型、t淋巴细胞计数和供者性别）能够预测12个月慢性GVHD的发病率，阳性预测值为75% %，阴性预测值为88% %。然而，IGRA并没有提高急性GVHD或血液学复发的预测价值。骨髓增生异常综合征（MDS）患者移植前IGRA值（p = 0.021）显著低于急性髓性白血病（AML）患者（分别为hsct后3个月和4个 月，p = 0.015和p = 0.0063），移植后IGRA中IFNγ反应延迟。结论：IGRA可用于监测造血干细胞移植后总细胞免疫的恢复，并显示出用于个性化移植后护理的潜力。在多变量逐步logistic回归模型中，移植前和移植后早期IGRA值显示出预测慢性GVHD的潜力。与AML患者相比，MDS患者移植前IGRA值显著降低，造血干细胞移植后IGRA中IFNγ反应延迟。

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Interferon gamma release assay has potential in the prediction of chronic graft-versus-host disease in recipients of myeloablative allogeneic hematopoietic stem cell transplantation with post-transplantation cyclophosphamide-based graft-versus-host disease prophylaxis

Background

The rate of immune reconstitution after allogeneic hematopoietic stem cell transplantation (allo-HSCT) plays the principal role in the development of serious post-transplant complications. However, the post-transplantation course has a significant impact on shaping the immune system of the recipient, per se, thus representing risk factors for subsequent unfavorable outcomes. The predictive power of an interferon gamma (IFNγ) release assay (IGRA) on graft-versus-host disease (GVHD) or hematological relapse in recipients of allo-HSCT treated with post-transplantation cyclophosphamide and the impact of these complications on the restoration of cellular immune responsiveness was evaluated.

Study design

A prospective observational study in which 62 adult patients with myeloid hematological malignancies who underwent allo-HSCT with a myeloablative conditioning regimen combined with post-transplantation cyclophosphamide were enrolled. Clinical data were collected and the IGRA was performed before commencement of the conditioning regimen and for 12 months post-allo-HSCT. Multivariate Cox regression and logistic regression models with backward stepwise analyses were used to calculate the predictive values for acute or chronic GVHD, or hematological relapse.

Results

Pre-transplantation and early post-transplantation IGRA values and other selected covariables (age, diagnosis, relapse risk, conditioning type, pre-T lymphocyte count, and donor sex), enabled prediction of the 12-month incidence of chronic GVHD with positive and negative predictive values of 75 % and 88 %, respectively. However, the IGRA did not improve the predictive value for acute GVHD or hematological relapse. Patients with myelodysplastic syndrome (MDS) had a significantly lower pre-transplant IGRA value (p = 0.021) and a delayed IFNγ response in IGRA, post-HSCT, than patients with acute myeloid leukemia (AML) (p = 0.015 and p = 0.0063 for 3 and 4 months post-HSCT, respectively).

Conclusions

The IGRA can be used to monitor the recovery of total cellular immunity, post-HSCT and it has shown potential for use in personalized post-transplantation care. In the multivariate backward stepwise logistic regression model, pre-and early post-transplantation IGRA values showed potential for predicting chronic GVHD. Patients with MDS had a significantly lower pre-transplantation IGRA value and delayed IFNγ response in IGRA, post-HSCT, than patients with AML.

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来源期刊

Transplant immunology 医学-免疫学

CiteScore

2.10

自引率

13.30%

发文量

198

审稿时长

48 days

期刊介绍： Transplant Immunology will publish up-to-date information on all aspects of the broad field it encompasses. The journal will be directed at (basic) scientists, tissue typers, transplant physicians and surgeons, and research and data on all immunological aspects of organ-, tissue- and (haematopoietic) stem cell transplantation are of potential interest to the readers of Transplant Immunology. Original papers, Review articles and Hypotheses will be considered for publication and submitted manuscripts will be rapidly peer-reviewed and published. They will be judged on the basis of scientific merit, originality, timeliness and quality.