Duration of immunosuppressive treatment for chronic graft-versus-host disease
Duration of immunosuppressive treatment for chronic graft-versus-host disease
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DOI：
10.1182/blood-2004-01-0200
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发表时间：
2004-12-01
期刊：
影响因子：
20.3
通讯作者：
Martin, PJ
中科院分区：
文献类型：
--
作者：
Stewart, BL;Storer, B;Martin, PJ
慢性移植物抗宿主病(GVHD)在造血细胞移植后需要长期的免疫抑制治疗。我们对751例慢性移植物抗宿主病患者进行了回顾性分析，以确定与免疫抑制治疗时间相关的特征。在274例慢性移植物抗宿主病缓解后复发或死亡前停止免疫抑制治疗的患者中，治疗时间的中位数为23个月。多变量模型的结果显示，接受外周血细胞移植的患者、女性捐献者的男性患者、移植物抗宿主人类白细胞抗原不匹配的患者、高胆红素血症患者或发病时受慢性GHVD影响的多部位患者的治疗时间延长。在HLA不匹配或高胆红素血症的患者中，无复发死亡率增加，但在那些有其他危险因素与长期治疗慢性移植物抗宿主病相关的患者中，无复发死亡率增加。在老年患者和老年供者中，在血小板计数低于100000/微升或急性移植物抗宿主病进行性发作的患者中，以及在诊断慢性移植物抗宿主病之前立即接受高剂量泼尼松治疗的患者中，无复发死亡率也增加。在考虑了泼尼松的剂量后，进展性发病与非复发死亡的风险增加无关。(C)2004年，由美国血液病学会提供。
Chronic graft-versus-host disease (GVHD) requires long-term immunosuppressive therapy after hematopoietic cell transplantation. We retrospectively analyzed a cohort of 751 patients with chronic GVHD to identify characteristics associated with the duration of immunosuppressive treatment. Among the 274 patients who discontinued immunosuppressive therapy after resolution of chronic GVHD before recurrent malignancy or death, the median duration of treatment was 23 months. Results of a multivariable model showed that treatment was prolonged in patients who received peripheral blood cells, in male patients with female donors, in those with graft-versus-host HLA mismatching, and in those with hyperbilirubinemia or multiple sites affected by chronic GHVD at the onset of the disease. Nonrelapse mortality was increased among patients with HLA mismatching or hyperbilirubinemia but not among those with other risk factors associated with prolonged treatment for chronic GVHD. Nonrelapse mortality was also increased in older patients and those with older donors, in patients with platelet counts less than 100000/muL or progressive onset of chronic GVHD from acute GVHD, and in those receiving higher doses of prednisone immediately before the diagnosis of chronic GVHD. After the dose of prednisone was taken into account, progressive onset was not associated with an increased risk of nonrelapse mortality. (C) 2004 by The American Society of Hematology.