Clinical characteristics and cytokine biomarkers in patients with chronic graft-vs-host disease persisting seven or more years after diagnosis.
Clinical characteristics and cytokine biomarkers in patients with chronic graft-vs-host disease persisting seven or more years after diagnosis.
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DOI：
10.1002/ajh.25717
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发表时间：
2020-04
影响因子：
12.8
通讯作者：
Pavletic SZ
中科院分区：
文献类型：
--
作者：
Goklemez S;Im AP;Cao L;Pirsl F;Steinberg SM;Curtis LM;Mitchell SA;Cowen EW;Baruffaldi J;Rose J;Mays J;Ostojic A;Holtzman NG;Hakim FT;Pavletic SZ
慢性移植物抗宿主病（cGVHD）是异基因造血干细胞移植（HSCT）后的主要晚期并发症。许多患者接受多线全身治疗直到cGVHD消退，但约15%的患者在cGVHD诊断后仍接受全身治疗超过7年。本研究描述了持续≥7年的cGVHD（持续性cGVHD）患者的临床和生物学因素。持续性cGVHD患者（n = 38）和cGVHD <1年（早期cGVHD）患者（n = 83）入选前瞻性横断面自然史研究。持续性cGVHD组患者从cGVHD诊断开始的中位时间为10.2年（范围7-27年）。58%的持续性cGVHD患者（22/38）接受全身免疫抑制，而早期cGVHD组为88%（73/83）。在多变量分析中，骨髓（BM）干细胞来源，存在ENA自身抗体，较高的NIH肺评分，较高的血小板计数和较高的伊加水平与持续性cGVHD显著相关。分析了一组高灵敏度的血清生物标志物，包括诊断cGVHD的七种细胞因子，并显示持续性cGVHD患者中BAFF和CXCL 10的水平显著较低。总之，标准公认的疾病严重程度的临床指标可能无法准确反映持续性cGVHD患者的疾病活动。然而，尽管缺乏疾病活动的证据，许多持续性cGVHD患者仍接受全身免疫抑制。cGVHD活性的可靠临床生物标志物的开发可能有助于指导未来的系统治疗。
Chronic graft-versus-host disease (cGVHD) is the leading late complication after allogeneic hematopoietic stem cell transplantation (HSCT). Many patients receive multiple lines of systemic therapy until cGVHD resolves, but about 15% remain on systemic treatment for more than 7 years after cGVHD diagnosis. This study describes the clinical and biological factors of patients who present with cGVHD persisting for ≥7 years (persistent cGVHD). Patients with persistent cGVHD (n = 38) and those with cGVHD for <1 year (early cGVHD) (n = 83) were enrolled in a prospective cross-sectional natural history study. Patients in the persistent cGVHD group were a median of 10.2 years from cGVHD diagnosis (range 7–27 years). Fifty-eight percent of persistent cGVHD patients (22/38) were receiving systemic immunosuppression, compared to 88% (73/83) in the early cGVHD group. In multivariable analysis, bone marrow (BM) stem cell source, presence of ENA autoantibodies, higher NIH lung score, higher platelet counts, and higher IgA levels were significantly associated with persistent cGVHD. A high sensitivity panel of serum biomarkers including seven cytokines diagnostic for cGVHD was analyzed and showed significantly lower levels of BAFF and CXCL10 in patients with persistent cGVHD. In conclusion, standardly accepted clinical measures of disease severity may not accurately reflect disease activity in patients with persistent cGVHD. However, many patients with persistent cGVHD are still receiving systemic immunosuppression despite lacking evidence of disease activity. Development of reliable clinical biomarkers of cGVHD activity may help guide future systemic treatments.
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影响因子：
4.8
作者：
Wolff D;Greinix H;Lee SJ;Gooley T;Paczesny S;Pavletic S;Hakim F;Malard F;Jagasia M;Lawitschka A;Hansen JA;Pulanic D;Holler E;Dickinson A;Weissinger E;Edinger M;Sarantopoulos S;Schultz KR
通讯作者：
Schultz KR
影响因子：
20.3
作者：
Kariminia, Amina;Holtan, Shernan G.;Schultz, Kirk R.
通讯作者：
Schultz, Kirk R.
影响因子：
4.3
作者：
Wolff, Daniel;Schleuning, Michael;Holler, Ernst
通讯作者：
Holler, Ernst
影响因子：
45.3
作者：
Wingard, John R.;Majhail, Navneet S.;Socie, Gerard
通讯作者：
Socie, Gerard
影响因子：
20.3
作者：
BENSINGER, WI;WEAVER, CH;BUCKNER, CD
通讯作者：
BUCKNER, CD