Abstract
IntroductionIt has rarely been studied that how the blood level of CsA affect the incidence of chronic GVHD after allogeneic hematopoietic stem cell transplantation (allo-HSCT).MethodsA total of 183 patients who underwent allo-HSCT from an HLA-matched or haplo matched family donors between 2006 and 2014 were reviewed.ResultsThe average monthly CsA blood concentration (CsAavr, ng/ml) was calculated in each patient: 0-1, 1-2, and 2-3 months after allo-HSCT. CsAavr at the first month showed significant association with the occurrence of moderate to severe cGVHD in multivariate analysis adjusted for gender, age, total body irradiation, anti-thymocyte globulin, acute GVHD ≥ grade 2 and CsAavr levels of other periods. The risk of cGVHD development was lowest in patients with CsAavr of 200-250 ng/ml when compared to those with CsAavr of ≥ 250 or < 200 ng/ml (p=0.003).ConclusionsCsA level between 200 and 250 mg/ml during the first month after transplantation was significantly associated with the decreased risk of moderate to severe cGVHD.
Highlights
It has rarely been studied that how the blood level of CsA affect the incidence of chronic graftversus-host disease (GVHD) after allogeneic hematopoietic stem cell transplantation
Total-body irradiation (TBI)-based conditioning was performed in patients (28.4%), and patients (29.0%) received anti-thymocyte globulin (ATG) during allo-hematopoietic stem cell transplantation (HSCT)
Acute GVHD was occurred in 51 patients (27.9%), 21 of whom experienced acute GVHD of grade 2 or more
Summary
It has rarely been studied that how the blood level of CsA affect the incidence of chronic GVHD after allogeneic hematopoietic stem cell transplantation (allo-HSCT). CsA is thought to bind to its specific immunophilin, cyclophilin, of immunocompetent lymphocytes, especially T-lymphocytes [13] This CNIimmunophilin complex inhibits calcineurin, which leads to a reduced function of effector T cells through inhibiting lymphokine production and interleukin release [14]. Close surveillance, it is not always easy to keep the CsA levels within the desired range Based on these findings, there have been interesting researches conferring impact of cyclosporine levels on the development of acute GVHD after allo-HSCT, in which higher CsA levels during early post-transplant period contributed to lower risk of acute GVHD [12, 16, 17]. The effect of blood level of CsA on the occurrence of chronic GVHD has rarely been studied
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