小剂量芦可替尼治疗38例急慢性移植物抗宿主病的疗效观察

The clinical efficacy and safety of low-doseruxolitinib in the treatment of 38 acute and chronic Graft-versus-host Disease Patients

目的评价采用小剂量芦可替尼治疗急慢性移植物抗宿主病(GVHD)的疗效及其安全性。方法回顾性分析2017年8月至2018年9月苏大附一院收治的38例急慢性GVHD受者,自移植后8个月(1~56)个月开始加用芦可替尼(口服,10 mg/d),症状缓解后5 mg/d,逐步减量至5 mg/2 d维持治疗。随访期内观察临床疗效并记录药物不良反应。结果38例受者服药中位时间63.5 d(7~316)d,27例(71.1%)完全缓解,8例(21.1%)部分缓解,3例(7.9%)无效,总体有效率为92.2%。服药后起效中位时间7 d(3~90)d,3例受者停药复发,继续芦可替尼治疗后完全或部分缓解。1例受者出现巨细胞病毒(CMV)肺炎后死亡,1例受者移植后复发死亡,余均存活。结论小剂量芦可替尼作为二线药物治疗急慢性移植物抗宿主病受者耐受性良好,并具有一定疗效。

Objective To evaluate the efficacy and safety of low-dose ruxolitinib in the treatment of patients with acute and chronic graft-versus-host disease(GVHD).Methods A retrospective analysis of 38 acute and chronic GVHD patients from August 2017 to September 2018 in our hospital.8(1-56)months after transplantation,we give ruxolitinib 5 mg twice per day on the basis of original immunosuppressors.After remission,it was reduced to 5mg once per day to 5 mg every other day.During this period,clinical efficacy was observed and adverse drug reactions were recorded.Results The median time of taking ruxolitinib was 63.5(7-316)days.In 38 patients,27 of them(71.1%)gained complete response,8(21.1%)gained partial response,3(7.9%)were ineffective,so the overall effective rate was 92.2%.The effective time after taking ruxolitinib was 7(3-90)days.Three patient had relapsed due to drug withdrawal and gained partial/complete remission after continuing treatment.One patient died in CMV pneumonia,one died in leukemia relapse and the rest survived.Conclusions Low-dose of ruxolitinib as a second-line drug for acute and chronic graft-versus-host patients are well tolerated and have certain efficacy.