(B43) A systematic review of the efficacy of sirolimus and methotrexate after hematopoietic stem cell transplantation

Publication Number: 653

Background: After hematopoietic stem cell allograft (HCT), donor immune cells may also attack normal host tissue, resulting in graft-versus-host disease (GVHD) phenomenon. It can be divided into acute graft versus host disease (aGVHD) and chronic graft versus host disease (cGVHD). This is also one of the major obstacles in the application of hematopoietic stem cell allotransplantation.Therefore, effective prevention is essential.

Objectives: To systematically evaluate the efficacy of sirolimus and methotrexate in the prevention of graft-versus-host disease after hematopoietic stem cell transplantation, so as to provide reference for clinical drug use.

Methods: Computer search CNKI, Wanfang, VIP, PubMed, Embase, Web of Science, The Cochrane Library databases. Keywords: hematopoietic stem cell transplantation, Sirolimus, rapamycin, methotrexate, methotrexate, metrefolate; hematopoietic stem cell transplantation, sirolimus, methotrexate, randomized controlled trial.
In this study, the Rev Man 5.3 software was used for meta-analysis. Odds ratio (OR) was used as the statistical analysis index for the effect of count data, and the operation results were represented by 95% confidence interval (95%CI). P < 0.05 was considered statistically significant.

Results: A total of 8 articles were included in this study, involving 1967 patients. Compared with methotrexate group, the incidence of 100-day aGVHD (II-IV) in Sirolimus group was lower [OR=0.50, 95%CI (0.28, 0.90), P=0.02], and the difference was statistically significant. The KPS score of 90-100% in the sirolimus group was significantly lower than that in the methotrexate group [OR=0.73, 95%CI(0.53, 0.99), P=0.04], indicating that patients in the Sirolimus group had worse physical function after transplantation.

Conclusions: Existing studies have suggested that sirolimus can reduce the incidence of aGVHD (II-IV) at 100 days after hematopoietic stem cell transplantation compared with methotrexate, but patients are in a worse state after transplantation. Currently, there are few studies comparing the clinical effects of Sirolimus and methotrexate after hematopoietic stem cell transplantation, and a larger sample size, multi-center, same-controlled clinical randomized controlled trial is needed to further evaluate the comparison of efficacy between Sirolimus and methotrexate. To provide more favorable evidence-based evidence for sirolimus and methotrexate in preventing graft-versus-host disease after hematopoietic stem cell transplantation.