發(fā)布時(shí)間：2018-01-16 02:03

  本文關(guān)鍵詞：伊馬替尼治療糖皮質(zhì)激素耐藥慢性移植物抗宿主病療效分析　出處：《浙江大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 異基因造血干細(xì)胞移植 糖皮質(zhì)激素耐藥慢性移植物抗宿主病 伊馬替尼 免疫抑制治療

【摘要】：目的:分析異基因造血干細(xì)胞移植(allogeneic hematopoietic stem cell transplantation,allo-HSCT)后糖皮質(zhì)激素耐藥慢性移植物抗宿主病(steroid-refractory chronic graft-versus-hostdisease,SRcGVHD)的臨床特點(diǎn),并探討伊馬替尼作為二線治療的療效及安全性。方法:回顧性分析2012年6月至2015年06月在我中心接受allo-HSCT 264例患者的臨床資料。對(duì)其中14例累及皮膚、肺、眼睛、口腔、肝臟、胃腸道等糖皮質(zhì)激素耐藥慢性移植物抗宿主病患者,加用伊馬替尼300mg/d二線治療,根據(jù)2014年NIH標(biāo)準(zhǔn)對(duì)cGVHD的總體療效及各個(gè)器官反應(yīng)進(jìn)行評(píng)價(jià)。結(jié)果:14例糖皮質(zhì)激素耐藥cGVHD患者在接受移植后中位時(shí)間為25個(gè)月時(shí),加用伊馬替尼300mg/d治療,評(píng)估3月療效獲得64.3%總體反應(yīng)率(Overall Response Rate,ORR),尚無(wú)患者獲得完全緩解,至6月時(shí)ORR上升至75.0%,CR率約為16.7%,其中皮膚、肺部、眼睛、口腔、關(guān)節(jié)、肝臟的ORR分別為50.0%、71.4%、100%、85.7%、100%、100%,相應(yīng)的 CR 率分別為 25.0%、14.3%、60.0%、71.4%、100%、100%。中位隨訪33個(gè)月,約50%患者可減少免疫抑制劑的維持劑量,并有1例患者完全撤藥。在伊馬替尼治療期間未發(fā)生嚴(yán)重的藥物相關(guān)性不良反應(yīng)。結(jié)論:伊馬替尼治療糖皮質(zhì)激素耐藥慢性移植物抗宿主病具有一定的臨床療效,且耐受性可,安全性佳,具有一定的臨床應(yīng)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.
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R457.7
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本文編號(hào)：1431032