Higher cyclosporine-A concentration increases the risk of relapse in AML following allogeneic stem cell transplantation from unrelated donors using anti-thymocyte globulin.

Autor: Lisak M; Department of Hematology and Coagulation, Sahlgrenska University Hospital, Bruna stråket 5, plan 5, 413 45, Gothenburg, Sweden. mikael.lisak@vgregion.se.; Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden. mikael.lisak@vgregion.se., Nicklasson M; Department of Hematology and Coagulation, Sahlgrenska University Hospital, Bruna stråket 5, plan 5, 413 45, Gothenburg, Sweden., Palmason R; Department of Hematology, Skane University Hospital, Lund, Sweden., Wichert S; Department of Hematology, Skane University Hospital, Lund, Sweden., Isaksson C; Department of Hematology, Norrland University Hospital, Umeå, Sweden., Andersson PO; Department of Hematology and Coagulation, Sahlgrenska University Hospital, Bruna stråket 5, plan 5, 413 45, Gothenburg, Sweden.; Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden., Johansson JE; Department of Hematology and Coagulation, Sahlgrenska University Hospital, Bruna stråket 5, plan 5, 413 45, Gothenburg, Sweden.; Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden., Lenhoff S; Department of Hematology, Skane University Hospital, Lund, Sweden., Brune M; Department of Hematology and Coagulation, Sahlgrenska University Hospital, Bruna stråket 5, plan 5, 413 45, Gothenburg, Sweden.; Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden., Hansson M; Department of Hematology and Coagulation, Sahlgrenska University Hospital, Bruna stråket 5, plan 5, 413 45, Gothenburg, Sweden.; Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.; Department of Hematology, Skane University Hospital, Lund, Sweden.
Jazyk: angličtina
Zdroj: Scientific reports [Sci Rep] 2023 Dec 20; Vol. 13 (1), pp. 22777. Date of Electronic Publication: 2023 Dec 20.
DOI: 10.1038/s41598-023-50105-4
Abstrakt: Cyclosporine-A (CsA) is used to prevent acute graft-versus-host disease (aGvHD). European Society for Blood and Marrow transplantation (EBMT) recommends a CsA target serum concentration of 200-300 µg/L during the first month after allogeneic hematopoietic stem cell transplantation (HSCT). With this study, we investigated whether a median CsA concentration > 200 µg/L (CsA high ) the first month after HSCT, compared to ≤ 200 µg/L (CsA low ), increased the relapse risk of acute myloid leukemia (AML), using unrelated donors (URD) and antithymocyte globulin (ATG). Data was collected from 157 patients with AML, transplanted 2010-2016. The cumulative incidence of relapse (CIR) at 60 months was 50% in the CsA high versus 32% in the CsA low group (p = 0.016). In univariate analysis, CsA high versus CsA low (p = 0.028), 10-unit increase of CsA as a continuous variable (p = 0.017) and high risk disease (p = 0.003) were associated with higher CIR. The results remained after adjusting for disease risk. Death following relapse occurred more frequently in the CsA high group (p = 0.0076). There were no significant differences in rates of aGvHD, chronic GvHD (cGvHD), EBV/CMV-infections or overall survival (OS) between the two groups. In conclusion, we found that a median CsA concentration > 200 µg/L, the first month after HSCT, results in higher CIR of AML when combined with ATG.
(© 2023. The Author(s).)
Databáze: MEDLINE
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