抗CD25单克隆抗体治疗非血缘脐血移植后激素耐药的急性GVHD的疗效分析

Feasibility of using CD25 monoclonal antibody for treating steroid-resistant acute GVHD occurring after unrelated umbilical cord blood transplantation(UCBT)

目的观察抗CD25单克隆抗体（巴利昔单抗）治疗非血缘脐带血造血干细胞移植（UCBT）后糖皮质激素耐药的急性移植物抗宿主病（aGVHD）的疗效。方法 2010年8月—2013年3月21例恶性血液病患者在安徽省立医院接受UCBT后发生中重度急性GVHD（其中Ⅱ度4例、Ⅲ度6例、Ⅳ度11例）,男11例,女10例,中位年龄12（3-33）岁,其中急性淋巴细胞白血病11例,急性髓细胞白血病10例。全部患者均接受环孢素（3 mg·kg^-1·d^-1,静脉滴注）和霉酚酸脂（30 mg·kg^-1·d^-1）并甲基强的松龙1-2 mg·kg^-1·d^-1无效后,加用巴利昔单抗每次20 mg,每周2次静脉点滴,连用3-4次,观察急性GVHD控制情况。结果 21例患者中完全缓解10例,部分缓解为7例,无效4例,总有效率81%。有效患者使用巴利昔单抗后平均起效的时间为6 d,巴利昔单抗开始使用时间和症状缓解开始时间存在相关性。结论抗CD25单抗对UCBT后发生的激素耐药的急性GVHD具有显著的疗效,无明显毒副作用,且应用时间越早,急性GVHD症状缓解越早。

Objective To observe the feasibility of using CD25 monoclonal antibody（Basiliximab） for treatment of steroid-resistant acute GVHD occurring after unrelated umbilical cord blood transplantation（UCBT）. Methods Basiliximab 20mg each by intravenous twice a week was given when it was invalid by using Methylprednisolone 1 - 2 mg·kg^-1·d^-1and MMF combined with cyclosporine（CsA 3 mg·kg^-1·d^-1,MMF 30 mg·kg^-1·d^-1） for 21 patients（male∶female =11∶10,median age of 12 years,ranging 3 -33years old）,developing GVHD after UCBT treatment. Among them,there were 11 cases of acute lymphoblastic leukemia and 10 cases of acute myeloid leukemia. The effect on GVHD and the infection of cytomegalovirus（CMV） were observed. All the patients were collected in Anhui Provincial Hospital from August 2010 to March 2013. Results There were 10 patients CR,7 patients PR and 4 patients NR,with an overall response rate of 81%. Symptoms in sensitive GVHD patients with treatment of CD25 for 1 - 11 d began to ease in an average alleviation time of 6 d. Conclusions CD25 has significant curative effect on steroid-resistant GVHD occurring after unrelated UCBT,without the increase incidence of infection. In addition,the earlier application of CD25,the sooner GVHD remit.