巴利昔单抗治疗糖皮质激素耐药/依赖急性移植物抗宿主病87例疗效分析

OBJECTIVE: To evaluate the efficacy and prognosis of basiliximab in the treatment of steroid-refractory or steroid-dependent acute graft-versus-host disease (SR/SD-aGVHD) after allogeneic hematopoietic stem cell transplantation (allo-HSCT). METHODS: Clinical data of 87 patients with SR/SD-aGVHD in the skin, intestine, and liver after allo-HSCT at the Institute of Hematology & Blood Diseases Hospital Transplantation Center from January 2015 to December 2018 were retrospectively analyzed. The administration plan of basiliximab was as follows: 20 mg for adults and children weighing ≥35 kg and 10 mg for children weighing <35 kg. The drug was administered once on the 1st, 4th, and 8th days, respectively, and then once weekly. The efficacy was evaluated on the 7th, 14th, 21st, and 28th days after basiliximab treatment. RESULTS: ①There were 51 males（58.6％）and 36 females（41.4％）, with a median（range）age of 34（4-63）years. There were 54 cases of classic aGVHD, 33 of late aGVHD, 49 of steroid-refractory aGVHD, and 38 of steroid-dependent aGVHD. ②Thirty-five patients（40.2％）achieved complete remission（CR）, 23（26.4％）achieved partial remission（PR）, and 29 had no remission（NR）. The total effective rate［overall response rate（ORR）］was 66.7％（58/87）. ③The ORR of the classic and late aGVHD groups was 77.8％（42/54）and 48.5％（16/33）, respectively. ④The median（range）follow-up time was 154（4–1813）days, the 6-month overall survival（OS）rate of the 87 patients was 44.8％（95％ CI 39.5％-50.1％）and the 1-year OS was 39.4％（95％ CI 34.2％–44.3％）. ⑤After treatment with basiliximab, the 6-month OS in the CR（35 cases）, PR（23 cases）, and NR（29 cases）groups was 80.0％（95％ CI 73.2％–86.8％）, 39.1％（95％ CI 28.9％–49.3％）, and 6.9％（95％ CI 2.2％–11.6％）, respectively（χ(2)＝34.679, P<0.001）, and the 1-year OS was 74.3％（95％ CI 66.9％–81.7％）, 30.4％（95％ CI 20.8％–40.0％）, and 3.4％（95％ CI 0％–6.8％）, respectively（χ(2)＝43.339, P<0.001）. The OS of the classic and late aGVHD groups was 57.4％（95％ CI 50.7％–64.1％）and 24.2％（95％ CI 16.7％–31.7％）, respectively（χ(2)＝9.109, P＝0.004）, and the 1-year OS was 51.9％（95％ CI 45.1％–58.7％）and 18.2％（95％ CI 11.5％–24.9％）, respectively（χ(2)＝9.753, P＝0.003）. ⑥Univariate and multivariate analyses showed that late aGVHD（OR＝3.121, 95％ CI 1.770–5.503, P<0.001）, Minnesota score high-risk group before medication（OR＝3.591, 95％ CI 1.931–6.679, P<0.001）, active infection before medication（OR＝1.881, 95％ CI 1.029–3.438, P＝0.040）, and impairment of important organ function caused by non-GVHD（OR＝3.100, 95％ CI 1.570–6.121, P＝0.001）were independent risk factors affecting the efficacy of basiliximab. CONCLUSION: Basiliximab has good efficacy and safety for SR/SD-aGVHD, but not in patients with late aGVHD, high-risk group of Minnesota score, and infection or impaired function of important organs.