目的 回顾性分析RAP无激素方案——“芦可替尼、阿奇霉素、吡非尼酮”治疗异基因造血干细胞移植（allogeneic hematopoietic stem cell transplantation，allo-HSCT）后中重度闭塞性细支气管炎综合征（bronchiolitis obliterans syndrome，BOS）的临床疗效及影响因素。 方法 纳入2018年1月1日至2023年12月31日于电子科技大学附属医院·四川省人民医院血液科行allo-HSCT并发生中重度BOS的患者14例，回顾性分析RAP无激素方案——“芦可替尼、阿奇霉素、吡非尼酮”的临床疗效及影响因素。 结果 ①有效率：3、6和12个月治疗总反应率分别为50.0%、57.1%和50.0%。治疗有效的8例患者在6个月时出现1秒用力呼气量（FEV1）%预测值（t=2.187，P=0.033）、6 min步行测试（t=2.338，P=0.023）、ECOG体能状态评分（t=2.681，P=0.013）和慢性移植物抗宿主病（chronic graft-versus-host disease，cGVHD）严重程度（Z=2.155，P=0.032）的明显改善。②生存：中位随访13（5，64）个月，5例（35.7%）死亡，死因为重症肺炎并发症。单因素分析提示RAP疗程延长与生存改善趋势相关（Wald值=2.892，P=0.089）。③激素暴露：14例均有长期糖皮质激素使用史，8例（57.1%）1个月内停用，2例（14.3%）减量50%以上。④安全性良好，主要不良反应为3级以下胃肠道反应及血液学毒性。 结论 RAP无激素方案治疗allo-HSCT后中重度BOS显示良好疗效，允许快速停用糖皮质激素，提高患者生活质量和长期生存。但限于小样本量和回顾性设计，有待前瞻性研究进一步验证。

Objective To retrospectively analyze the clinical efficacy of the RAP（Ruxolitinib，Azithromycin，and Pirfenidone） hormone-free regimen in the treatment of moderate to severe BOS and its influencing factors. Methods This study included 14 patients who developed moderate to severe BOS after undergoing allo-HSCT at our center from January 1，2018 to December 31，2023. These patients were retrospectively analyzed for the clinical efficacy of the RAP hormone-free regimen and its influencing factors. Results ①The overall response rates at 3，6 and 12 months of treatment were 50.0%，57.1%，and 50.0%，respectively. At the six-months post RAP regimen，the FEV1% predicted value（t=2.187，P=0.033），6 minute walk test（t=2.338，P=0.023），ECOG physical state score（t=2.681，P=0.013） and cGVHD severity（Z=2.155，P=0.032） of 8 patients who responded to the RAP treatment were significantly improved. ②Survival： During a median follow-up of 13 months，5 patients（35.7%） died of severe pneumonia complications. Univariate analysis showed that the extended course of RAP treatment was correlated with a trend of survival improvement（P=0.089）. ③Glucocorticoid exposure：all 14 cases had a long-term history of glucocorticoid use，8 cases（57.1%） discontinued glucocorticoid use within 1 month，and 2 cases reduced their dose by more than 50%. ④The safety profile was favorable，and the main adverse reactions were gastrointestinal reactions and hematological toxicity. Conclusion The RAP hormone-free regimen shows a favorable effect in the treatment of moderate to severe BOS. It allows for the rapid withdrawal of glucocorticoids and improves the quality of life and long-term survival of patients. However，it needs to be further verified by prospective studies due to its small sample size and retrospective design.