Severity of chronic graft-versus-host disease: association with treatment-related mortality and relapse
Severity of chronic graft-versus-host disease: association with treatment-related mortality and relapse
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DOI：
10.1182/blood.v100.2.406
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发表时间：
2002-07-15
期刊：
影响因子：
20.3
通讯作者：
Horowitz, MM
中科院分区：
文献类型：
--
作者：
Lee, SJ;Klein, JP;Horowitz, MM
慢性移植物抗宿主病（cGVHD）是异基因骨髓和血液移植受者晚期治疗相关死亡的主要原因。然而，cGVHD也与较少的复发有关。我们试图确定cGVHD的严重程度是否能预测这些影响的程度。这种分析的一个障碍是目前有限/广泛的cGVHD分级系统，因为这种分类旨在识别可能受益于全身免疫抑制的患者，而不能捕获多器官受累的严重程度。因此，我们首先利用国际骨髓移植登记处（IBMTR）报告的1827例hla匹配的同胞同种异体移植受者的数据，开发了一个预测生存的分级系统。我们发现Karnofsky评分、腹泻、体重减轻、皮肤和口腔受累是独立的预后变量，我们据此制定了评分方案。我们对来自IBMTR的1092名hla匹配的兄弟姐妹移植受者和来自国家骨髓捐赠计划的553名非血缘供体骨髓受者进行了平行分析，测试了该方案、有限/广泛分类系统和基于总体cGVHD严重程度（轻度/中度/重度）的临床印象分类。在3项分析中，cGVHD的存在与较少的复发相关（相对风险[RR]， 0.5-0.6），但与治疗相关的死亡率更高（RR, 1.8-2.8）。没有评分方案将cGVHD严重程度与复发率联系起来，但所有方案都预测了治疗相关的死亡率。每种方案中最有利的cGVHD组的生存期和无病生存期与无cGVHD组相似或更好；这些患者可能不需要积极的或延长的免疫抑制。（Blood. 2002; 100:406-414）。(C) 2002年由美国血液病学会出版。
Chronic graft-versus-host disease (cGVHD) is the leading cause of late treatment-related deaths among recipients of allogeneic bone marrow and blood transplants. However, cGVHD is also associated with fewer relapses. We sought to determine whether severity of cGVHD predicts the magnitude of these effects. One impediment to such an analysis is the current limited/extensive grading system for cGVHD because this classification was designed to identify patients likely to benefit from systemic immune suppression and does not capture the severity of multiorgan involvement. We, therefore, first developed a grading system predictive for survival by using data from 1827 HLA-matched sibling allotransplant recipients reported to the International Bone Marrow Transplant Registry (IBMTR). We found Karnofsky performance score, diarrhea, weight loss, and cutaneous and oral involvement to be independent prognostic variables, from which we generated a grading scheme. We tested this scheme, the limited/extensive classification system, and a classification based on clinical impression of overall cGVHD severity (mild/moderate/severe) in parallel analyses of 1092 HLA-matched sibling transplant recipients from the IBMTR and 553 recipients of unrelated donor marrow from the National Marrow Donor Program. Presence of cGVHD was associated with fewer relapses (relative risk [RR], 0.5-0.6) but more treatment-related mortality (RR, 1.8-2.8) in the 3 analyses. No grading scheme correlated cGVHD severity with relapse rates, but all schemes predicted treatment-related mortality. Survival and disease-free survival of the most favorable cGVHD group in each scheme were similar, or better, than those of patients without cGVHD; these patients may not need aggressive or extended immune suppression. (Blood. 2002; 100:406-414). (C) 2002 by The American Society of Hematology.