Sirolimus versus imatinib in patients with steroid-refractory chronic graft-versus-host disease: a retrospective analysis of a single-center

Abstract

Objective To compare the efficacy and prognosis of imatinib and sirolimus as second-line treatment for steroid-refractory chronic graft-versus-host disease (SR-cGVHD) after allogeneic hematopoietic stem cell transplantation (allo-HSCT). Methods Clinical data of 33 patients diagnosed as SR-cGVHD after allo-HSCT in the Medical Center of Hematology of Army Medical University from September 2017 to December 2020 were collected and analyzed retrospectively. Among them, 16 patients were treated with imatinib and 17 with sirolimus. The response rate at the time points of 6 months and 1 year after initiation of second-line treatment, 2-year overall survival (OS), 2-year disease free survival (DFS), 1-year failure free survival and drug-related toxicity were compared between the 2 groups. Results For the imatinib and sirolimus patients, their 6-month overall response rate (ORR) was 62.5% and 41.2% (P=0.303), while 1-year ORR was 73.3% and 43.8% (P=0.149), 6-month complete response (CR) rate was 12.5% and 23.5% (P=0.656), while 1-year CR rate was 20.0% and 31.3% (P=0.685), respectively, and no statistical significance was observed between the 2 groups. The patients with imatinib treatment achieved better outcomes than those treated with sirolimus in terms of 2-year OS and 2-year DFS (P=0.041, P=0.043). There was no significant difference in the occurrence of drug-related toxicity between the 2 groups. Conclusion Imatinib and sirolimus shows similar response rate to SR-cGVHD after allo-HSCT, but the former is superior to the latter in terms of short-term OS and DFS.

Keywords

• chronic graft-versus-host disease
• allogeneic hematopoietic stem cell transplantation
• imatinib
• sirolimus