Abstract
This study aimed to observe the safety and clinical efficacy of early application of ruxolitinib to prevent acute graft-versus-host disease (aGVHD) after alternative donor transplantation in acute leukemia. There were 57 patients undergoing allo-HSCT at the Affiliated Cancer Hospital of Zhengzhou University from July 2017 to October 2019. They were divided into control(16 patients) and ruxolitinib (41 patients) groups. For aGVHD prophylaxis, the control group received post-transplantation cyclophosphamide, antithymocyte globulin-Fresenius, cyclosporine A, and mycophenolate mofetil, while in the ruxolitinib group, ruxolitinib 5 mg/d in adults or 0.07–0.1 mg/(kg d) in children was administered from the day of neutrophil engraftment to 100 days post-transplantation based on control group. We found 55 patients had successful reconstitution of hematopoiesis; No significant difference was found in cGVHD, hemorrhagic cystitis, pulmonary infection, intestinal infection, Epstein-Barr virus infection, cytomegalovirus infection, relapse, death, and nonrelapse mortality. The incidences of aGVHD (50 vs. 22%, P = 0.046) and grade II–IV aGVHD (42.9 vs. 12.2%, P = 0.013) were significantly higher in the control group than in the ruxolitinib group. No significant differences were observed in overall survival (P = 0.514), disease-free survival (P = 0.691), and cumulative platelet transfusion within 100 days post-transplantation between two groups. This suggests early application of ruxolitinib can reduce the incidence and severity of aGVHD and patients are well tolerated.
Highlights
B cells, natural killer cells, and neutrophils)[10]
Many clinical studies were performed on the application of ruxolitinib in the treatment of GVHD, confirming that ruxolitinib was effective in steroid-refractory GVHD (SR-GVHD) with few side effects it didn’t increase the risk of recurrence of malignant tumors[14,15,16,17,18]
A total of 57 patients were screened (Table 1 and Fig. 1), we comprehensively evaluate the medical condition, the risk of GVHD, financial status and willingness of patients to choose to use ruxolitinib. 16 of whom agreed with common anti-GVHD therapy. 41 of whom agreed with ruxolitinib and common anti-GVHD therapy
Summary
Activated JAKs are necessary for effector T-cell responses in different inflammatory diseases, and their blockade can potentially reduce acute GVHD11. They are expected to become a new target for the prevention and treatment of GVHD. Preclinical studies showed that ruxolitinib has good anti-GVHD effects; it has anti-GVHD activity but retains the GVL e ffect[12]. Reports on the efficacy of ruxolitinib in preventing GVHD, appropriate dosage, patient tolerance, and impact on survival and prognosis were few. The present study mainly retrospectively analyzed the clinical efficacy and safety of the early application of ruxolitinib to prevent aGVHD after transplantation, so as to provide new ideas and directions for the prevention of aGVHD
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