Replacement of Calcineurin Inhibitor with Ruxolitinib as GVHD Prophylaxis during Patients with Vascular Endothelial Syndromes after Allogeneic Stem Cell Transplantation

Hanyin-Liang*, Zhiping-Fan, Hong-Chen, Dongmei-Luo, Zherou-He, Zicheng-Gao, Ziyu-Wen, Qifa-Liu and Na Xu

Department of Hematology, Southern Medical University, China

^*Correspondance to: Hanyin-Liang 

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Abstract:

Background: Vascular Endothelial Syndromes (VES) are a range of life-threatening complications that after allogeneic Hematopoietic Stem Cell Transplantation (HSCT), including Transplant-Associated Thrombotic Microangiopathy (TA-TMA), Veno-Occlusive Disease/Sinusoidal Obstruction Syndrome (VOD/SOS), Capillary Leak Syndrome (CLS), Engraftment Syndrome (ES) and Idiopathic Pneumonia Syndrome (IPS)/Diffuse Alveolar Hemorrhage (DAH). Changing immunosuppressive regimen is an important initial step to manage VES because Calcineurin Inhibitors (CNIs) maybe contribute to endothelial cells injury. Our study aimed to determine the therapeutic value of replacing Calcineurin Inhibitors (CNIs) by ruxolitinib during patients with VES.
Methods: 25 patients with hematopoietic malignancies after all o-SCT who developed VES enrolled in this study. All patients received ruxolitinib to replace CNI as GVHD prophylaxis. Ruxolitinib was initiated at 5 mg ~ 10 mg twice a day until 28 days, and then tapered gradually followed by cyclosporine with complete remission of VES therapy.
Results: All 25 patients received CNI with or no MMF as GVHD prophylaxis when diagnosed VES, among them, 12 patients with TA-TMA, 4 patients with CLS, 7 patients with SOS/VOD, and 2 patients diagnosed ES. After ruxolitinib replacement, 18 (72%) patients achieved complete remission of VES. Cytomegalovirus (CMV) and Epstein-Barr Virus (EBV) reactivation occurred in
52% (13/25) and 36% (9/25) patients, respectively.
Conclusion: Our data demonstrate that replacement of calcineurin inhibitors with ruxolitinib is a promising treatment option to improve the therapeutic outcome of vascular endothelial syndromes following hematopoietic cell transplantation, but the effect of infection on efficacy should be noted.

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Cite the Article:

Hanyin-Liang, Zhiping-Fan, Hong-Chen, Dongmei-Luo, Zherou-He, Zicheng-Gao, et al. Replacement of Calcineurin Inhibitor with Ruxolitinib as GVHD Prophylaxis during Patients with Vascular Endothelial Syndromes after Allogeneic Stem Cell Transplantation.
Clin Oncol. 2022;7:1959..