伊马替尼治疗糖皮质激素耐药慢性移植物抗宿主病疗效分析

发布时间：2018-01-16 02:03

  本文关键词：伊马替尼治疗糖皮质激素耐药慢性移植物抗宿主病疗效分析　出处：《浙江大学》2017年硕士论文　论文类型：学位论文

  更多相关文章： 异基因造血干细胞移植 糖皮质激素耐药慢性移植物抗宿主病 伊马替尼 免疫抑制治疗

【摘要】：目的:分析异基因造血干细胞移植(allogeneic hematopoietic stem cell transplantation,allo-HSCT)后糖皮质激素耐药慢性移植物抗宿主病(steroid-refractory chronic graft-versus-hostdisease,SRcGVHD)的临床特点,并探讨伊马替尼作为二线治疗的疗效及安全性。方法:回顾性分析2012年6月至2015年06月在我中心接受allo-HSCT 264例患者的临床资料。对其中14例累及皮肤、肺、眼睛、口腔、肝脏、胃肠道等糖皮质激素耐药慢性移植物抗宿主病患者,加用伊马替尼300mg/d二线治疗,根据2014年NIH标准对cGVHD的总体疗效及各个器官反应进行评价。结果:14例糖皮质激素耐药cGVHD患者在接受移植后中位时间为25个月时,加用伊马替尼300mg/d治疗,评估3月疗效获得64.3%总体反应率(Overall Response Rate,ORR),尚无患者获得完全缓解,至6月时ORR上升至75.0%,CR率约为16.7%,其中皮肤、肺部、眼睛、口腔、关节、肝脏的ORR分别为50.0%、71.4%、100%、85.7%、100%、100%,相应的 CR 率分别为 25.0%、14.3%、60.0%、71.4%、100%、100%。中位随访33个月,约50%患者可减少免疫抑制剂的维持剂量,并有1例患者完全撤药。在伊马替尼治疗期间未发生严重的药物相关性不良反应。结论:伊马替尼治疗糖皮质激素耐药慢性移植物抗宿主病具有一定的临床疗效,且耐受性可,安全性佳,具有一定的临床应用前景。
[Abstract]:Objective: to analyze allogeneic hematopoietic stem cell transplantation. Chronic graft-versus-host disease with glucocorticoid resistance after allo-HSCT. Steroid-refractory chronic graft-versus-hostdisease. Clinical features of SRcGV HD. To evaluate the efficacy and safety of imatinib as a second line therapy methods: to retrospectively analyze the efficacy and safety of allo-HSCT in our center from June 2012 to June 2015. Clinical data of 264 patients. 14 of them involved skin. Patients with chronic graft-versus-host disease with glucocorticoid resistance, including lung, eyes, mouth, liver, gastrointestinal tract, and other glucocorticoids were treated with imatinib 300mg / d second-line therapy. According to NIH standard in 2014, the overall efficacy and organ response of cGVHD were evaluated. Results:. Fourteen patients with glucocorticoid resistant cGVHD received a median time of 25 months after transplantation. An additional 300mg / d of imatinib was used to assess the overall response rate of 64.3% Response / ORR in March. By June, ORR had risen to 75.0% and the CR rate was about 16.7.The ORR of skin, lungs, eyes, mouth, joints and liver were 50.0%, respectively. The corresponding CR rate was 25.0% and 14.30.50%, 71.4% and 100%, respectively. A median follow-up of 33 months showed that about 50% patients could reduce the maintenance dose of immunosuppressants. There was no serious adverse drug reaction during the treatment of imatinib. Conclusion:. Imatinib has a certain clinical effect in the treatment of glucocorticoid resistant chronic graft-versus-host disease. It has good tolerance and safety, and has a certain clinical application prospect.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R457.7
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