抗胸腺细胞球蛋白与抗CD3单克隆抗体治疗皮质激素耐药的急性移植物抗宿主病的疗效比较

Antithymocyte Globulin vs Anti-CD3 Monoclonal Antibody Therapy for Patients with Steroid-resistant Acute Graft-versus-host Disease

摘要: 目的　比较抗胸腺细胞球蛋白 (ATG)和抗CD3单克隆抗体联合大剂量甲基强的松龙 (MP)治疗皮质激素耐药急性移植物抗宿主病 (aGVHD)的疗效。方法　 11例异基因外周血干细胞移植的病患者, 移植后发生Ⅲ～Ⅳ度aGVHD, 经大剂量MP治疗 3～ 9d无效后接受ATG(ATG组 )或抗CD3单克隆抗体 (WuT3组 )联合大剂量MP治疗。ATG 2 .5mg/ (kg·d), 连续 5～ 7d ;WuT35mg/ (kg·d), 10～ 14d后停药 ;MP 5mg/ (kg·d), aGVHD控制后逐渐减量。结果　ATG组 :7例中 4例获完全缓解 (CR)、2例部分缓解 (PR)、1例无效 (NR), 总有效率 85 .7%。WuT3组 :1例获CR、1例PR、2例NR, 1例获CR患者至今已存活 8个月, 缓解后出现CMV阳性。 4例中有 3例治疗中合并感染。结论　ATG联合大剂量MP治疗皮质激素耐药aGVHD优于抗CD3单克隆抗体。早期ATG联合大剂量MP治疗激素耐药的aGVHD具有较高的疗效。

Abstract: Objective To observe the therapeutic effect of antithymocyte globulin combined with high dose methylprednisolone (ATG group) vs anti CD3 monoclonal antibody (WuT3 group) combined with high dose methylprednisolone(MP) on steroid refractory acute graft versus host disease (aGVHD). Methods Eleven patients with grade Ⅲ or Ⅳ aGVHD after allo HSCT who failed to respond to high dose MP were treated with ATG 2.5mg/(kg·d) for 5 to 7daysor WuT3(5mg/d for 10to 14 days). All patients continued to rec...