The Clinical Characteristics and Prognostic Factors of Acute Graft-Versus-Host Disease in Stem Cell Transplant Patients Treated with Cyclosporine
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Background
Calcium-modulated inhibitors are commonly used after allogeneic haematopoietic stem cell transplantation (allo-HSCT), and the risk factors for the development of acute graft-versus-host disease (aGVHD) may differ among immunosuppressive regimens, presenting a challenge for clinical prediction. Cyclosporine (CsA) is a frequently used immunosuppressant in the postoperative period. By investigating the clinical characteristics and risk factors of aGVHD in allo-HSCT treated with the CsA regimen, we aspire to furnish evidence-based proof for patients applying CsA after allo-HSCT.
Methods
This retrospective study based on the clinical data of patients who received allo-HSCT and used CsA in the First Affiliated Hospital of Guangxi Medical University from June 2020 to July 2023, calculated the incidence rate of aGVHD, and analyzed the risk factors of poor prognosis through logical regression. Simultaneously perform ROC curve analysis.
Results
A total of 129 subjects were enrolled in this study, among whom 19 patients developed aGVHD. The sites of aGVHD involvement were skin in 11 cases (57.9%) and intestine in 8 cases (42.1%). Univariate analysis results showed that CsA concentration on days 15 ~ 21 after transplantation, bacterial infection before transplantation, fungal infection before transplantation, and pretreatment programme were the associated factors with aGVHD. Multifactorial analysis revealed that CsA concentration on days 15~21 after transplantation (OR=0.987, 95% CI=0.978~0.997, P =0.011), CsA dose-normalized concentration on days 15 ~ 21 after transplantation (OR=1.015, 95% CI=1.001 ~ 1.029, P =0.035), bacterial infection before transplantation (OR=0.255, 95%CI=0.079 ~ 0.823, P =0.022), and pretreatment programme (OR=0.488, 95% CI=0.252 ~ 0.944, P =0.033) were independent risk factors for aGVHD. After transplantation, the ideal threshold of CsA concentration is 136.45 ng/ml.
Conclusion
This study highlights the necessity for patients undergoing allo-HSCT and receiving CsA regimens to be particularly vigilant about the pretreatment programme, the monitoring of CsA or CsA dose-normalized concentration on days 15 ~ 21 after transplantation, and to avoid bacterial infections before surgery.
