Graft-versus-Host Disease Treatment: Predictors of Survival
Graft-versus-Host Disease Treatment: Predictors of Survival
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DOI：
10.1016/j.bbmt.2010.05.019
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发表时间：
2010-12-01
影响因子：
4.3
通讯作者：
Weisdorf, Daniel
中科院分区：
文献类型：
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作者：
Levine, John E.;Logan, Brent;Weisdorf, Daniel
异基因造血细胞移植（HCT）后的急性移植物抗宿主病（aGVHD）是非复发死亡率（NRM）的主要原因，因此是长期存活的主要决定因素。需要对新的aGVHD治疗进行临床试验，以确定最终改善HCT存活率的方法。目前，尚不清楚需要多快建立对GVHD治疗的反应，以可靠地将患者分类为因此，我们分析了180例患者从aGVHD治疗开始到反应的时间，这些患者参加了一项国家随机11期aGVHD治疗临床试验，其GVHD的初始治疗包括高剂量类固醇加第二种免疫抑制剂。反应预测患者结局，尤其是生存期。我们使用从aGVHD治疗开始后14、28和56天的反应来对患者进行NRM和生存期分类。（完全或部分缓解）根据NRM和从aGVHD治疗开始后9个月的生存率对患者进行最佳分类，如果证实为晚期结局的可靠预测因素，其他aGVHD治疗方法第28天反应应作为aGVHD治疗未来试验的标准早期终点Biol Blood Marrow Transplant 16 1693-1699（2010）（C）2010年美国血液和骨髓移植学会
Acute graft versus-host disease (aGVHD) following allogeneic hematopoietic cell transplant (HCT) is the major reason for nonrelapse mortality (NRM) and thus is a major determinant of long-term survival Clinical trials of new aGVHD treatments are needed to identify approaches that will ultimately improve upon HCT survival At present it is not clear how quickly response to GVHD treatment needs to be established to reliably categorize patients at high risk for death or to promptly identify those who might benefit from alternate treatment Therefore we analyzed time to response from onset of aGVHD treatment in 180 patients who were enrolled on a national randomized phase 11 aGVHD treatment clinical trial whose initial treatment of GVHD consisted of high dose steroids plus a second immunosuppressive agent The aim of this analysis was to determine whether time to aGVHD treatment response predicts patient outcomes especially survival We used response at 14 28 and 56 days from initiation of aGVHD treatment to categorize patients for NRM and survival Multivariate analyses and specificity/sensitivity analyses identified that day 28 response (complete or partial response) best categorized patients by NRM and survival at 9 months from start of aGVHD treatment If verified as a reliable predictor of late outcomes following other aGVHD treatment approaches day 28 response should serve as a standard early endpoint for future trials of aGVHD therapy Biol Blood Marrow Transplant 16 1693-1699 (2010) (C) 2010 American Society for Blood and Marrow Transplantation