Vorinostat plus tacrolimus and mycophenolate to prevent graft-versus-host disease after related-donor reduced-intensity conditioning allogeneic haemopoietic stem-cell transplantation: a phase 1/2 trial

被引：104

作者：

Choi, Sung Won ^{[1
]}

Braun, Thomas ^{[2
]}

Chang, Lawrence ^{[1
]}

Ferrara, James L. M. ^{[1
]}

Pawarode, Attaphol ^{[1
]}

Magenau, John M. ^{[1
]}

Hou, Guoqing ^{[1
]}

Beumer, Jan H. ^{[4
]}

Levine, John E. ^{[1
]}

Goldstein, Steve ^{[1
]}

Couriel, Daniel R. ^{[1
]}

Stockerl-Goldstein, Keith ^{[5
]}

Krijanovski, Oleg I. ^{[6
]}

Kitko, Carrie ^{[1
]}

Yanik, Gregory A. ^{[1
]}

Lehmann, Michael H. ^{[3
]}

Tawara, Isao ^{[7
]}

Sun, Yaping ^{[1
]}

Paczesny, Sophie ^{[8
]}

Mapara, Markus Y. ^{[9
]}

Dinarello, Charles A. ^{[10
,11
]}

DiPersio, John F. ^{[3
]}

Reddy, Pavan ^{[1
]}

机构：

[1] Univ Michigan, Blood & Marrow Transplantat Program, Ann Arbor, MI 48109 USA

[2] Univ Michigan, Dept Biostat, Ann Arbor, MI 48109 USA

[3] Univ Michigan, Dept Cardiol, Ann Arbor, MI 48109 USA

[4] Univ Pittsburgh, Pittsburgh, PA USA

[5] Washington Univ, Blood & Marrow Transplantat Program, St Louis, MO USA

[6] Sutter East Bay Med Fdn, Berkeley, CA USA

[7] Mie Univ Hosp, Tsu, Mie, Japan

[8] Indiana Univ, Indianapolis, IN 46204 USA

[9] Columbia Univ, Blood & Marrow Transplantat Program, New York, NY USA

[10] Univ Colorado, Dept Med, Aurora, CO USA

[11] Univ Med Ctr Nijmegen, Dept Med, Nijmegen, Netherlands

来源：

LANCET ONCOLOGY | 2014年 / 15卷 / 01期

基金：

美国国家卫生研究院;

关键词：

HISTONE DEACETYLASE INHIBITOR; SUBEROYLANILIDE HYDROXAMIC ACID; REGULATORY T-CELLS; INDUCTION; CANCER; MICE;

D O I：

10.1016/S1470-2045(13)70512-6

中图分类号：

R73 [肿瘤学];

学科分类号：

100214 ;

摘要：

Background Acute graft-versus-host disease (GVHD) remains a barrier to more widespread application of allogeneic haemopoietic stem-cell transplantation. Vorinostat is an inhibitor of histone deacetylases and was shown to attenuate GVHD in preclinical models. We aimed to study the safety and activity of vorinostat, in combination with standard immunoprophylaxis, for prevention of GVHD in patients undergoing related-donor reduced-intensity conditioning haemopoietic stem-cell transplantation. Methods Between March 31, 2009, and Feb 8, 2013, we did a prospective, single-arm, phase 1/2 study at two centres in the USA. We recruited adults (aged >= 18 years) with high-risk haematological malignant diseases who were candidates for reduced-intensity conditioning haemopoietic stem-cell transplantation and had an available 8/8 or 7/8 HLA-matched related donor. All patients received a conditioning regimen of fludarabine (40 mg/m(2) daily for 4 days) and busulfan (3.2 mg/kg daily for 2 days) and GVHD immunoprophylaxis of mycophenolate mofetil (1 g three times a day, days 0-28) and tacrolimus (0.03 mg/kg a day, titrated to a goal level of 8-12 ng/mL, starting day -3 until day 180). Vorinostat (either 100 mg or 200 mg, twice a day) was initiated 10 days before haemopoietic stem-cell transplantation until day 100. The primary endpoint was the cumulative incidence of grade 2-4 acute GVHD by day 100. This trial is registered with ClinicalTrials.gov, number NCT00810602. Findings 50 patients were assessable for both toxic effects and response; eight additional patients were included in the analysis of toxic effects. All patients engrafted neutrophils and platelets at expected times after haemopoietic stem-cell transplantation. The cumulative incidence of grade 2-4 acute GVHD by day 100 was 22% (95% CI 13-36). The most common non-haematological adverse events included electrolyte disturbances (n=15), hyperglycaemia (11), infections (six), mucositis (four), and increased activity of liver enzymes (three). Non-symptomatic thrombocytopenia after engraftment was the most common haematological grade 3-4 adverse event (nine) but was transient and all cases resolved swiftly. Interpretation Administration of vorinostat in combination with standard GVHD prophylaxis after related-donor reduced-intensity conditioning haemopoietic stem-cell transplantation is safe and is associated with a lower than expected incidence of severe acute GVHD. Future studies are needed to assess the effect of vorinostat for prevention of GVHD in broader settings of haemopoietic stem-cell transplantation.

引用

页码：87 / 95

页数：9

共 30 条

[11] Phase I study of an oral histone deacetylase inhibitor, suberoylanilide hydroxamic acid, in patients with advanced cancer [J].