甲氨蝶呤治疗异基因造血干细胞移植后的移植物抗宿主病

Methotrexate for treatment of graft versus host disease after allogeneic hematopoietic stem cell transplantation

目的 评价小剂量甲氨蝶呤治疗异基因造血干细胞移植(Allo HSCT)后移植物抗宿主病(GVHD)的疗效。方法 对31例I～II度急性GVHD(aGVHD)、慢性GVHD(cGVHD)和供者淋巴细胞输注后(post DLI)GVHD患者予以甲氨蝶呤5或10mg,静脉点滴,每5～7d1次,直至GVHD症状消失/缓解、判断甲氨蝶呤无效或毒副作用不能耐受。结果 aGVHD组、cGVHD组和post DLIGVHD组总有效率分别为94%、75%和100%。皮肤型、肠道型、肝脏型、口腔型和眼型的总有效率分别为100%、60%、71%、75%和100%。甲氨蝶呤相关的毒副作用均可耐受。本治疗可减少其他免疫抑制剂的用量。结论 小剂量、短期内应用甲氨蝶呤可以安全有效地治疗Allo HSCT后的I～II度aGVHD、cGVHD和post DLIGVHD。

Objective To evaluate the efficacy and safety of low-dose methotrexate in patients with graft versus host disease (GVHD) after allogeneic hematopoietic stem cell transplantation (Allo-HSCT). Methods Thirty-one patients with minor or moderate grade acute GVHD (aGVHD), chronic GVHD (cGVHD) or GVHD post donor lymphocyte infusion (post-DLI GVHD) after Allo-HSCT received intravenously administrated methotrexate at a dose of 5 or 10mg every 5 to 7 days until achieving complete or partial responses, treatment failure or intolerable side effects. Results The overall response rate was 93.8% (15/16 patients) in patients with aGVHD, 75% (12/16 patients) in patients with cGVHD and 100% (2/2 in patients) with post-DLI GVHD. The response rate for GVHD involving organs was 100% in skin, 60% in gut, 71% in liver, 75% in mouth and 100% in eyes. Side effects were minor. During the therapy, the other immunosuppressive agents were reduced. Conclusion Short-term low-dose methotrexate is a tolerable and effective regimen for patients with minor or moderate grade aGVHD, cGVHD or post-DLI GVHD after Allo-HSCT.