Clinical analysis of sirolimus as an alternative GVHD prophylaxis for patients with kidney injury undergoing allo-HSCT
10.3760/cma.j.cn112138-20230306-00136
- VernacularTitle:异基因造血干细胞移植后合并肾功能不全患者使用西罗莫司替代环孢素预防GVHD的临床分析
- Author:
Wei SUN
1
;
Rui MA
;
Yun HE
;
Lu BAI
;
Yuhong CHEN
;
Yao CHEN
;
Yuanyuan ZHANG
;
Jingzhi WANG
;
Huan CHEN
;
Xiaohui ZHANG
;
Lanping XU
;
Yu WANG
;
Xiaojun HUANG
;
Yuqian SUN
Author Information
1. 北京大学人民医院 北京大学血液病研究所 国家血液系统疾病临床医学研究中心 造血干细胞移植治疗血液病北京市重点实验室，北京 100044
- Keywords:
Hematopoietic stem cell transplantation;
Sirolimus;
Graft vs host disease
- From:
Chinese Journal of Internal Medicine
2023;62(12):1444-1450
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To explore the feasibility of sirolimus as an alternative graft versus host disease (GVHD) prophylaxis in patients with kidney injury after allogeneic hematopoietic stem cell transplantation (allo-HSCT).Methods:Retrospective case series study. Medical records of 11 patients in Peking University People′s Hospital from 1 August 2008 to 31 October 2022, who received sirolimus instead of cyclosporine to prevent GVHD, due to renal insufficiency after allo-HSCT, were analyzed retrospectively. Incidence of GVHD, infection, and transplant-associated thrombotic microangiopathy (TA-TMA), as well as renal function, were evaluated.Results:Among the 11 patients who received sirolimus, 6 were treated with haploidentical donor HSCT, and 5 were treated using matched sibling donor HSCT. The median (range) time of sirolimus administration was 30 (7-167) days after allo-HSCT, and the median (range) sirolimus course duration was 52 (9-120) days. During sirolimus treatment, 1 case did not undergo combined treatment with other prophylactic drugs, 3 cases received combined mycophenolate mofetil (MMF), and 1 case underwent combined CD25 monoclonal antibody treatment, while 6 cases had combined therapy with both MMF and CD25 monoclonal antibody. Of the 11 patients, 2 developed Grade Ⅲ acute GVHD, 1 developed severe pneumonia and died, and 1 developed TA-TMA, while nine patients had normal or improved renal function. Median (range) follow-up time was 130 (54-819) days. Non-relapse mortality was observed in 1 patient. Relapse mortality was also observed in 1 patient.Conclusion:Sirolimus-based alternative GVHD prophylaxis is a potentially viable option for patients undergoing allo-HSCT who cannot tolerate cyclosporine, but its efficacy and safety require further optimization and verification in prospective studies.
