异基因造血干细胞移植术后环孢素A全血谷浓度的有效范围研究

Study on the Effective Range of the Whole Blood Trough Concentration of Cyclosporine A after Allogeneic Hematopoietic Stem Cell Transplantation

目的:探讨异基因造血干细胞移植术后环孢素A(CsA)全血谷浓度与急性移植物抗宿主病(aGVHD)的相关性,明确CsA全血谷浓度的有效范围。方法:对23例异基因造血干细胞移植术后患者的全血CsA谷浓度与其aGVHD发生情况进行回顾性分析。结果:CsA谷浓度在50～100ng·mL-1组的Ⅱ～Ⅳ级aGVHD发生率最高(43.66%),其次是100～150ng·mL-1组的32.50%,再次是150～200ng·mL-1组的7.35%,前2组发生率显著高于第3组(P<0.01);在CsA谷浓度>200ng·mL-1时出现Ⅳ级aGVHD的为同一患者,除外无Ⅱ级以上aGVHD发生。结论:异基因造血干细胞移植术后患者的全血CsA谷浓度与aGVHD的发生率及严重程度有关。CsA谷浓度维持在200～250ng·mL-1可减少aGVHD的发生及药品不良反应。

OBJECTIVE： To study the relationship between the acute graft-versus-host disease （aGVHD） and the whole blood concentration of cyclosporine A （CsA） after allogeneic hematopoietic stem cell transplantation, and to definite the effective range of the whole blood trough concentration of CsA. METHODS： The occurrence of aGVHD and the whole blood trough concentration of CsA in 23 patients after allogeneic hematopoietic stem cell transplantation were analyzed retrospectively. RESULTS： The inci- dence of Ⅱ -Ⅳ degree aGVHD was the highest （43.66%） as trough concentration of CsA ranged 50-100 ng.mL-1, followed by 32.50% in the range of 100-150 ng-mL-1 and 7.35% in the range of 150-200 ng-mL-1. The incidence of the former two groups was significantly higher than the latter （P〈0.01）. The above Ⅱ degree aGVHD had not occurred when the trough concentration of CsA was more than 200 ng.mL-1 except for one patient suffered from Ⅳ degree aGVHD. CONCLUSION： The whole blood trough concentration of CsA is closely related to the incidence and severity of the aGVHD in the patients after allogeneie hematopoietic stem ceil transplantation. When it is maintained between 200-250 ng.mL-1, the occurrence of aGVHD and ADR can be reduced.