백혈병 환아에서 동종 조혈모세포 이식 후 Cyclosporine의 혈중 농도와 이식편대 숙주질환 및 재발률과의 상관관계
The impact of cyclosporine on graft-versus-host disease and relapse rate after allogenic hematopoietic stem cell transplantation in children with leukemia
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Abstract
Graft-versus-host disease(GVHD) is correlated with high mortality and morbidity after transplantation. However, GVHD could lower relapse rate through a graft-versus-tumor effect and improve survival. Recent large retrospective studies evaluate that the patient with acute or chronic GVHD is associated with decresed relapse rate. Also, a prospective trial in pediatric patients suggest that low dose of cyclosporine(CsA) is associated with statistically significant reduction in leukemic relapse. Therefore, the purpose of this study was to assess the influence of blood CsA concentration on GVHD and leukemic relapse. From september 1999 to october 2004, we studied 35 pediatric patients(40 transplantation cases) with leukemia who had received an allogenic hematopoietic stem cell transplantation in Pediatric Hemato-Oncology of Seoul National University Children Hospital. We retrospectively analyzed the age of transplantation, body surface area, sex, interval from diagnosis to transplantation, white blood cell(WBC) count at diagnosis, remission status, stem cell source, donor, compatibility of sex and blood type, conditioning regimen, GVHD prophylactic regimen, blood CsA concentration, GVHD incidence, relapse rate, graft failure, and mortality were analyzed. Also, a subgroup analysis was performed in 17 children who had more than three blood CsA concentrations which were sampled at the period of intravenous administration. There was no significant difference in patient related and transplant related characteristics, mean blood CsA concentration and relapse rate between the group with GVHD and non-GVHD. On subgroup analysis, there was no significant difference in patient related characteristics, the incidence of GVHD, relapse rate and mortality between the group of over the mean concentration and under the mean concentration at the period of intravenous administration. The blood CsA concentration was not a significant factor in the incidence of GVHD and leukemic relapse rate. However, the incidence of GVHD was too low to analyze exactly. Therefore, a prospective controlled study is needed for the enough patient number.
참고문헌 (18)
- McGlave, P., "Unrelated donor marrow transplantation therapy for chronic myelogenous leukemia - Initial experience of the National Marrow Donor Program", Blood, 81, pp.543~ (1993)
- Devergie, A., "European results of matched unrelated donor bone marrow transplantation for chronic myelogenous leukemia. Impact of HLA class II matching", Bone Marrow Transplant, 20, pp.11~ (1997)
- 민창기, "비혈연간 또는 HLA 부분 일치 혈연간 동종 골수이식에서 급성 이식편대 숙주 질환 예방", 대한조혈모세포이식학회지, 4, pp.185~ (1999)
- Sullivan, K.M., "Influence of acute and chronic graft-versus-host disease on relapse and survival after bone transplantation from HLA-identical sibling as treatment of acute and chronic leukemia", Blood, 75, pp.1720~ (1989)
- Horowitz, M.M., "Graft-versus-leukemia reactions after bone marrow transplantation", Blood, 75, pp.555~ (1990)
- Ringd´en, O., "Graftversus- leukemia effect in allogeneic marrow transplant recipients with acute leukemia is maintained using cyclosporin A combined with methotrexate as prophylaxis. Acute Leukemia Working Party of the European Group for Blood and Marrow Transplantation", Bone Marrow Transplant, 18, pp.921~ (1996)
- Barrett, A.J., "Graftversus- leukaemia understanding and using the alloimmune response to treat haematological malignancies", Br J Haematol, 93, pp.754~ (1996)
- Ringd´en, O., "Strong antileukemic effect of chronic graft-versus- host disease in allogeneic marrow transplant recipients having acute leukemia treated with methotrexate and cyclosporine. The Acute Leukemia Working Party of the European Group for Blood and Marrow Transplantation (EBMT)", Transplant Proc, 29, pp.733~ (1997)
- Passweg, J.R., "Graft-versus leukemia effects in T lineage and B lineage acute lymphoblastic leukemia", Bone Marrow Transplant, 21, pp.153~ (1998)
- Zikos, P., "Allogeneic hematopoietic stem cell transplantation for patients with high risk acute lymphoblastic leukemia. Favorable impact of chronic graft-versus-host disease on survival and relapse", Haematologica, 83, pp.896~ (1998)
- Locatelli, F., "Graft versus host disease prophylaxis with low-dose cyclosporine-A reduces the risk of relapse in children with acute leukemia given HLA identical sibling bone marrow transplantation.Results of a randomized trial", Blood, 95, pp.1572~ (2000)
- Teuffel, O., "The impact of cyclosporin A on acute graft-versushost disease after allogeneic bone marrow transplantation in children and adolescents with acute lymphoblastic leukemia", Bone Marrow Transplant, 36(2), pp.145~ (2005)
- 홍대식, "한국인의 동종골수이식후 이식편대숙주 질환의 빈도, 예측인자 및 임상적 결과에 관한 연구", 대한조혈모세포이식학회지, 4, pp.59~ (1999)
- Storb, R., "Methotrexate and cyclosporine compared with cyclosporine alone for prophylaxis of acute graft versus host disease after marrow transplantation for leukemia", N Engl J Med, 314, pp.729~ (1986)
- Ruutu, T., "A survey of the prophylaxis and treatment of acute GVHD in Europe. A report of the European Group for Blood and Marrow Transplantation (EBMT). Chronic Leukaemia Working Party of the EBMT", Bone Marrow Transplant, 19, pp.759~ (1997)
- Lee, J.W., "Regimens for Graft-Versus- Host disease prophylaxis in allogeneic bone marrow transplantation", 대한조혈모 세포이식학회지, 1, pp.1~ (1996)
- Elmaagacli, A.H., "The risk of residual molecular and cytogenetic disease in patients with Philadelphia-chromosome positive first chronic myelogenous leukemia is reduced after transplantation of allogeneic peripheral blood stem cells compared with bone marrow", Blood, 94, pp.384~ (1999)
- Gratwohl, A., "Acute graft-versus-host disease. Grade and outcome in patients with chronic myelogenous leukemia. Working Party Chronic Leukemia of the European Group for Blood and Marrow Transplantation", Blood, 86, pp.813~ (1995)