不同供者来源干细胞移植术后环孢素A有效血药浓度的监测分析

Monitoring of effective blood concentration of cyclosporin A after stem cell transplantation from different donors

目的分析无关供者及亲缘供者异基因造血干细胞移植术后环孢素A(CsA)的血药浓度及其与急性移植物抗宿主病(aGVHD)和不良反应(ADR)之间的关系,比较两者移植术后CsA的有效血药浓度。方法根据供者来源,将42例异基因造血干细胞移植患者分为无关供者组(21例)和亲缘供者组(21例),采用酶放大免疫测定法,对其术后CsA全血谷浓度进行监测分析。结果 42例移植患者中562例次监测结果提示:CsA有效浓度为200~400 ng·mL^-1,当其浓度> 400 ng·mL^-1,时,ADR发生率达到46.42%,其中无关供者组为29.66%,亲缘供者组为16.76%;当其浓度<200 ng·mL^-1,aGVHD发生率为35.86%,其中无关供者组为18.18%,亲缘供者组为17.68%,两者差异无统计学意义(P> 0.05)。结论无关供者异基因造血干细胞移植术后,虽然ADR和aGVHD发生率要高于亲缘供者组,但两者差异并无统计学意义,因而可作为造血干细胞移植的选择。

Objective To determine the relationship between the plasma concentration of cyclosporine A(CsA) and acute graft-versus-host disease(aGVHD) and adverse reactions(ADR) after allogeneic hematopoietic stem cell transplantation from unrelated or related donors, and to compare the effective blood concentration of CsA after the transplantation in both groups. Methods Totally 42 patients with allogeneic hematopoietic stem cell transplantation were divided into an unrelated donor group and a related donor group according to the source of donor. Enzyme amplification immunoassay was used to monitor the whole blood valley concentration of CsA after the operation. Results The total 562 monitorings of the 42 transplant patients showed that the effective concentration was 200-400 ng·mL^-1,. When the concentration was > 400 ng·mL^-1,, the ADR incidence reached 46.42%(29.66% in the unrelated donor group and 16.76% in the related donor group). The aGVHD occurred in 35.86% patients(18.18% in the unrelated donor group and 17.68% in the related donor group) when the concentration was < 200 ng·mL^-1,, with no significant difference in the two groups(P > 0.05). Conclusion Incidence of ADR and aGVHD from unrelated donors after allogeneic hematopoietic stem cell transplantation is higher than that from related donors, but with no significant difference in both groups, so both can be used in hematopoietic stem cell transplantation.