Graft-versus-host disease after nonmyeloablative versus conventional hematopoietic stem cell transplantation
Graft-versus-host disease after nonmyeloablative versus conventional hematopoietic stem cell transplantation
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DOI：
10.1182/blood-2002-08-2628
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发表时间：
2003-07-15
期刊：
影响因子：
20.3
通讯作者：
Storb, R
中科院分区：
文献类型：
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作者：
Mielcarek, M;Martin, PJ;Storb, R
目前尚不清楚与清髓性造血干细胞移植（HSCT）相比，非成髓性造血干细胞移植后移植物抗宿主病（GVHD）的严重程度、时间和质量是否不同。因此，回顾性分析了44例接受非消融性HSCT和52例接受消融性HSCT的患者（中位年龄分别为56岁和54岁）的GVHD发生率、皮肤、肝脏和肠道的发病率、免疫抑制治疗的需求和生存率。非烧蚀性移植方案包括低剂量全身照射（TBI），氟达拉滨给药之前，在一些患者中，然后在所有患者的免疫抑制剂与霉酚酸酯（MMF）和环孢素（CSP）。接受清髓性HSCT的患者接受不同的含TBI和不含TBI的方案，并接受CSP加甲氨蝶呤或MMF预防GVHD。非消融性移植后II-IV级急性GVHD的累积发生率较低（64% vs 85%; P = .001），但需要治疗的慢性GVHD的累积发生率无差异（73% vs 71%; P = .96）。非烧蚀性移植与GVHD激素治疗开始时间延迟（0.95个月vs 3.0个月; P <0.001）和移植后前3个月使用较少的全身免疫抑制剂有关（P <0.04）。这对应于非消融性移植后6至12个月更普遍的皮肤和更严重的肠道发病率。我们的研究结果表明，非消融性造血干细胞移植与急性移植物抗宿主病综合征发生后100天，在许多患者。在设计前瞻性研究比较两种类型移植程序导致的GVHD时，应考虑到这种“迟发性急性GVHD”。(C)2003年，美国血液学会。
It is unknown whether the severity, timing, and quality of graft-versus-host disease (GVHD) may be different after nonmyeloalblative as compared with myeloablative hematopoietic stem cell transplantation (HSCT). Therefore, GVHD incidence, morbidity of skin, liver, and gut, requirements for immunosuppressive therapy, and survival were retrospectively analyzed in 44 patients who underwent nonablative HSCT and 52 who underwent ablative HSCT (median ages, 56 and 54 years, respectively). The nonablative transplantation regimen consisted of low-dose total body irradiation (TBI), preceded in some patients by fludarabine administration and followed in all patients by immunosuppression with mycophenolate mofetil (MMF) and cyclosporine (CSP). Those who underwent myeloablative HSCT were prepared with different TBI- and non-TBI-containing regimens and received CSP plus methotrexate or MMF for GVHD prophylaxis. The cumulative incidence of grades II-IV acute GVHD was lower after nonablative transplantation (64% vs 85%; P = .001), but there were no differences in the cumulative incidence of chronic GVHD requiring treatment (73% vs 71%; P = .96). Nonablative transplantation was associated with the delayed initiation of steroid treatment for GVHD (0.95 months vs 3.0 months; P < .001) and with the use of fewer systemic immunosuppressants in the first 3 months after transplantation (Pless than or equal to .04). This corresponded to more prevalent skin and more severe gut morbidity 6 to 12 months after nonablative transplantation. Our results show that nonablative HSCT is associated with a syndrome of acute GVHD occurring after day 100 in many patients. This "late-onset acute GVHD" should be taken into consideration in the design of prospective studies comparing GVHD resulting from the two types of transplantation procedures. (C) 2003 by The American Society of Hematology.