重组抗CD25人源化单克隆抗体挽救性治疗糖皮质激素耐药型急性移植物抗宿主病64例疗效分析

Humanized anti-CD25 monoclonal antibody as a salvage therapy for steroid-refractory acute graft-versus-host disease after hematopoietic stem cell transplantation

目的分析重组抗CD25人源化单克隆抗体(人源化CD25单抗)治疗异基因造血干细胞移植后糖皮质激素耐药型急性移植物抗宿主病(SR-aGVHD)的疗效。方法纳入2019年6月至2020年10月在苏州弘慈血液病医院接受人源化CD25单抗治疗的64例异基因造血干细胞移植后SR-aGVHD患者,所有患者予人源化CD25单抗1 mg·kg^(-1)·d^(-1)第1、3、8天各1次,此后根据病情每周1次。在人源化CD25单抗治疗后第7、14、28天进行疗效评估。结果64例患者中男38例(59.4%),女26例(40.6%),中位年龄31(15~63)岁。64例SR-aGVHD患者人源化CD25单抗治疗后第7、14、28天有效率分别为48.4%(31/64)、53.1%(34/64)、79.7%(51/64)。肝脏受累是人源化CD25单抗治疗SR-aGVHD第28天疗效不佳的独立危险因素(OR=9.588,95%CI 0.004~0.291,P=0.002)。从人源化CD25单抗治疗开始随访,所有患者的中位随访时间为17.1(0.2~50.8)个月。治疗后12、24个月总生存率分别为63.2%(95%CI 57.1%~69.3%)、52.6%(95%CI 46.1%~59.1%),无病生存率分别为58.4%(95%CI 52.1%~64.7%)、49.8%(95%CI 43.4%~56.2%),非复发死亡率分别为28.8%(95%CI 23.1%~34.5%)、32.9%(95%CI 26.8%~39.0%)。多因素分析结果显示,肝脏受累(OR=0.308,95%CI 0.108~0.876,P=0.027)和Ⅲ/Ⅵ度aGVHD(OR=9.438,95%CI 1.211~73.577,P=0.032)是影响移植后总生存的独立危险因素。结论人源化CD25单抗对于异基因造血干细胞移植后SR-aGVHD有较好的疗效。

Objective To investigate the efficacy of humanized anti-CD25 monoclonal antibody for steroid-refractory acute graft-versus-host disease(SR-aGVHD)in allogeneic hematopoietic stem cell transplantation(allo-HSCT)recipients.Methods A total of 64 patients with SR-aGVHD between June 2019 and October 2020 in Suchow Hopes Hematology Hospital were enrolled in this study.Humanized anti-CD25 monoclonal antibodies 1 mg·kg^(-1)·d^(-1) were administered on days 1,3,and 8,and then once per week according to the disease progression.Efficacy was assessed at days 7,14,and 28 after humanized anti-CD 25 treatment.Results Of the 64 patients with a median age of 31(15–63)years,38(59.4%)were male and 26(40.6%)were female.The overall response(OR)rate of the humanized CD25 monoclonal antibody in 64 patients with SR-aGVHD on days 7,14,and 28 were 48.4%(31/64),53.1%(34/64),and 79.7%(51/64),respectively.Liver involvement is an independent risk factor for poor efficacy of humanized CD25 monoclonal antibody for SR-aGVHD at day 28(OR=9.588,95%CI 0.004–0.291,P=0.002).The median follow-up time for all patients was 17.1(0.2–50.8)months from the start of humanized CD25 monoclonal antibody therapy.The 1-and 2-year OS rates were 63.2%(95%CI 57.1%–69.3%)and 52.6%(95%CI 46.1%–59.1%),respectively.The 1-and 2-year DFS rates were 58.4%(95%CI 52.1%–64.7%)and 49.8%(95%CI 43.4%–56.2%),respectively.The 1-and 2-year NRM rates were 28.8%(95%CI 23.1%–34.5%)and 32.9%(95%CI 26.8%–39.0%),respectively.The results of the multifactorial analysis showed that liver involvement(OR=0.308,95%CI 0.108–0.876,P=0.027)and GVHD gradeⅢ/Ⅳ(OR=9.438,95%CI 1.211–73.577,P=0.032)were independent risk factors for OS.Conclusion Humanized CD25 monoclonal antibody has good efficacy and safety for SR-aGVHD.This study shows that SR-aGVHD with pretreatment gradeⅢ/ⅣGVHD and GVHD involving the liver has poor efficacy and prognosis and requires early intervention.