Vinita Dhir, Connor Prince, David Allan, Harold Atkins, Christopher Bredeson, Natasha Kekre, Michael Kennah, Ashish Masurekar, Ram Vasudevan Nampoothiri
{"title":"在抗胸腺细胞球蛋白(ATG)预防GVHD的情况下,黏膜炎导致的第11天甲氨蝶呤剂量调整对同种异体干细胞移植后预后的影响。","authors":"Vinita Dhir, Connor Prince, David Allan, Harold Atkins, Christopher Bredeson, Natasha Kekre, Michael Kennah, Ashish Masurekar, Ram Vasudevan Nampoothiri","doi":"10.1111/ejh.14380","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Dose adjustments of Day 11 Methotrexate (MTx) for GVHD prophylaxis after allogeneic hematopoietic stem cell transplantation (HCT) are common due to mucositis, renal injury, or other reasons. The impact of omitting or adjusting doses of MTx in the era of ATG-based GVHD prophylaxis remains unexplored.</p><p><strong>Methods: </strong>We retrospectively analyzed the outcomes of all adult patients undergoing allogeneic HCT who received ATG-based GVHD prophylaxis at The Ottawa Hospital from January 2019 to December 2022. We compared outcomes of patients having only Day 11 MTx dose reductions due to mucositis(MTxRD group) with patients receiving full dose MTx on all 4 days (MTxFD group). The impact of Day 11 MTx dose reduction on outcomes were assessed using Kaplan-Meier analyses and log rank test.</p><p><strong>Results: </strong>Three hundred and four patients (median age 58 [17-74] years; 64% male) underwent allogeneic HCT during the study period. Baseline characteristics were similar between the MTxRD group (n = 69) and MTxFD group (n = 199) except for an increased proportion of MAC regimens in MTxRD group. The incidence of severe aGVHD (7.2% vs. 7.5%; p = 0.96) and chronic GVHD (15.9% vs. 15.6%; p = 0.89) were not different between the two groups. The 2-year OS (59% vs. 69.8%; p = 0.11), GRFS (42.4% vs. 47.6%; p = 0.32), NRM (17.7% vs. 12.2%; p = 0.45) or relapse/progression (CIR 27.4 vs. 26.6%; p = 0.55) were also similar between the two groups.</p><p><strong>Conclusions: </strong>In patients receiving ATG-based GVHD prophylaxis regimens, there were similar GVHD and survival outcomes in patients who received no or reduced D11 MTx when compared to full dose MTx. Dose adjustments of D11 MTx due to mucositis appear to be safe in the era of ATG-based GVHD prophylaxis regimens.</p>","PeriodicalId":11955,"journal":{"name":"European Journal of Haematology","volume":" ","pages":""},"PeriodicalIF":2.3000,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Impact of Day 11 Methotrexate Dose Adjustments due to Mucositis on the Outcomes Following Allogeneic Stem Cell Transplant in the Setting of Anti Thymocyte Globulin (ATG) Based GVHD Prophylaxis.\",\"authors\":\"Vinita Dhir, Connor Prince, David Allan, Harold Atkins, Christopher Bredeson, Natasha Kekre, Michael Kennah, Ashish Masurekar, Ram Vasudevan Nampoothiri\",\"doi\":\"10.1111/ejh.14380\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Dose adjustments of Day 11 Methotrexate (MTx) for GVHD prophylaxis after allogeneic hematopoietic stem cell transplantation (HCT) are common due to mucositis, renal injury, or other reasons. The impact of omitting or adjusting doses of MTx in the era of ATG-based GVHD prophylaxis remains unexplored.</p><p><strong>Methods: </strong>We retrospectively analyzed the outcomes of all adult patients undergoing allogeneic HCT who received ATG-based GVHD prophylaxis at The Ottawa Hospital from January 2019 to December 2022. We compared outcomes of patients having only Day 11 MTx dose reductions due to mucositis(MTxRD group) with patients receiving full dose MTx on all 4 days (MTxFD group). The impact of Day 11 MTx dose reduction on outcomes were assessed using Kaplan-Meier analyses and log rank test.</p><p><strong>Results: </strong>Three hundred and four patients (median age 58 [17-74] years; 64% male) underwent allogeneic HCT during the study period. Baseline characteristics were similar between the MTxRD group (n = 69) and MTxFD group (n = 199) except for an increased proportion of MAC regimens in MTxRD group. The incidence of severe aGVHD (7.2% vs. 7.5%; p = 0.96) and chronic GVHD (15.9% vs. 15.6%; p = 0.89) were not different between the two groups. The 2-year OS (59% vs. 69.8%; p = 0.11), GRFS (42.4% vs. 47.6%; p = 0.32), NRM (17.7% vs. 12.2%; p = 0.45) or relapse/progression (CIR 27.4 vs. 26.6%; p = 0.55) were also similar between the two groups.</p><p><strong>Conclusions: </strong>In patients receiving ATG-based GVHD prophylaxis regimens, there were similar GVHD and survival outcomes in patients who received no or reduced D11 MTx when compared to full dose MTx. 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引用次数: 0
摘要
背景:同种异体造血干细胞移植(HCT)后第11天调整甲氨蝶呤(MTx)预防GVHD的剂量是常见的,原因是粘膜炎、肾损伤或其他原因。在以atg为基础的GVHD预防时代,忽略或调整MTx剂量的影响仍未得到探讨。方法:回顾性分析2019年1月至2022年12月在渥太华医院接受基于atg的GVHD预防的所有同种异体HCT成年患者的结局。我们比较了仅第11天因黏膜炎而减少MTx剂量的患者(MTxRD组)和全部4天接受全剂量MTx的患者(MTxFD组)的结果。使用Kaplan-Meier分析和log rank检验评估第11天MTx剂量减少对结果的影响。结果:304例患者(中位年龄58[17-74]岁;(64%男性)在研究期间接受了同种异体HCT。MTxRD组(n = 69)和MTxFD组(n = 199)的基线特征相似,除了MTxRD组中MAC方案的比例增加。重度aGVHD的发生率(7.2% vs. 7.5%;p = 0.96)和慢性GVHD (15.9% vs. 15.6%;P = 0.89)差异无统计学意义。2年OS (59% vs 69.8%;p = 0.11), GRFS (42.4% vs. 47.6%;p = 0.32), NRM (17.7% vs. 12.2%;p = 0.45)或复发/进展(CIR 27.4 vs. 26.6%;P = 0.55),两组之间也相似。结论:在接受基于atg的GVHD预防方案的患者中,与全剂量MTx相比,未接受或减少D11 MTx的患者的GVHD和生存结果相似。在以atg为基础的GVHD预防方案时代,由于粘膜炎而调整D11 MTx的剂量似乎是安全的。
Impact of Day 11 Methotrexate Dose Adjustments due to Mucositis on the Outcomes Following Allogeneic Stem Cell Transplant in the Setting of Anti Thymocyte Globulin (ATG) Based GVHD Prophylaxis.
Background: Dose adjustments of Day 11 Methotrexate (MTx) for GVHD prophylaxis after allogeneic hematopoietic stem cell transplantation (HCT) are common due to mucositis, renal injury, or other reasons. The impact of omitting or adjusting doses of MTx in the era of ATG-based GVHD prophylaxis remains unexplored.
Methods: We retrospectively analyzed the outcomes of all adult patients undergoing allogeneic HCT who received ATG-based GVHD prophylaxis at The Ottawa Hospital from January 2019 to December 2022. We compared outcomes of patients having only Day 11 MTx dose reductions due to mucositis(MTxRD group) with patients receiving full dose MTx on all 4 days (MTxFD group). The impact of Day 11 MTx dose reduction on outcomes were assessed using Kaplan-Meier analyses and log rank test.
Results: Three hundred and four patients (median age 58 [17-74] years; 64% male) underwent allogeneic HCT during the study period. Baseline characteristics were similar between the MTxRD group (n = 69) and MTxFD group (n = 199) except for an increased proportion of MAC regimens in MTxRD group. The incidence of severe aGVHD (7.2% vs. 7.5%; p = 0.96) and chronic GVHD (15.9% vs. 15.6%; p = 0.89) were not different between the two groups. The 2-year OS (59% vs. 69.8%; p = 0.11), GRFS (42.4% vs. 47.6%; p = 0.32), NRM (17.7% vs. 12.2%; p = 0.45) or relapse/progression (CIR 27.4 vs. 26.6%; p = 0.55) were also similar between the two groups.
Conclusions: In patients receiving ATG-based GVHD prophylaxis regimens, there were similar GVHD and survival outcomes in patients who received no or reduced D11 MTx when compared to full dose MTx. Dose adjustments of D11 MTx due to mucositis appear to be safe in the era of ATG-based GVHD prophylaxis regimens.
期刊介绍:
European Journal of Haematology is an international journal for communication of basic and clinical research in haematology. The journal welcomes manuscripts on molecular, cellular and clinical research on diseases of the blood, vascular and lymphatic tissue, and on basic molecular and cellular research related to normal development and function of the blood, vascular and lymphatic tissue. The journal also welcomes reviews on clinical haematology and basic research, case reports, and clinical pictures.