ACUTE GRAFT-VERSUS-HOST DISEASE - GRADE AND OUTCOME IN PATIENTS WITH CHRONIC MYELOGENOUS LEUKEMIA
ACUTE GRAFT-VERSUS-HOST DISEASE - GRADE AND OUTCOME IN PATIENTS WITH CHRONIC MYELOGENOUS LEUKEMIA
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DOI：
10.1182/blood.v86.2.813.bloodjournal862813
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发表时间：
1995-07-15
期刊：
影响因子：
20.3
通讯作者：
NIEDERWIESER, D
中科院分区：
文献类型：
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作者：
GRATWOHL, A;HERMANS, J;NIEDERWIESER, D
急性移植物抗宿主病（aGVHD）已根据西雅图标准分为0、I、II、III和IV级20年。这种详细分级的预测价值是一个有争议的问题;出版物通常报告GVHD存在或不存在或不存在，中度或重度。欧洲骨髓移植工作组的慢性白血病分析了1,294例在第一慢性期从同种异体供体移植的慢性髓细胞性白血病（CML）患者的数据，并测试了aGVHD分级对以下终点的预测价值：第100天死亡率（D100 M）、移植相关死亡率（TRM）、复发率（RI）、无白血病存活率（LFS）和存活率（SURV）。462例患者（35.7%）无aGVHD，335例（25.8%）发生I级，264例（20.5%）发生II级，110例（8.5%）发生III级，123例（9.5%）发生IV级。共有297名患者（23%）在100天内死亡，495名患者（38%）死于任何TRM，100名患者（8%）死于复发。根据0、I、II、III和IV级，D100 M分别为17%、13%、19%、38%和70%，0-II级与III-IV级之间存在显著差异。TRM分别为28%、27%、43%、68%和92%，0-I与II-IV之间存在明显分离。随着aGVHD的增加，RI分别下降37%、30%、23%、18%和8%。LFS分别为45%、51%、44%、26%和7%，对于I级aGVHD患者最好。这一发现也反映在更好的总生存率（分别为60%，64%，53%，30%和8%）。多变量分析证实I级aGVHD患者的LFS优于0级或II级aGVHD患者（P = 0.05）。这些数据记录了目前aGVHD 5分分级的价值，即根据分析的终点观察到不同的结局。将关于aGVHD的信息限制为存在或不存在是不必要的。(C)1995年，美国血液学会。
Acute graft-versus-host disease (aGVHD) has been classified according to the Seattle criteria as grades 0, I, II, III, and IV for 20 years. The predictive value of such detailed grading is a matter of debate; publications usually report GVHD as present or absent or as absent, moderate, or severe. The Working Party Chronic Leukemia of the European Group for Bone Marrow Transplantation analyzed data of 1,294 patients transplanted from an allogeneic donor for chronic myelogenous leukemia (CML) in first chronic phase and tested the predictive value of aGVHD grading for the following endpoints: day 100 mortality (D100M), transplant-related mortality (TRM), relapse incidence (RI), leukemia-free survival (LFS), and survival (SURV). aGVHD was absent in 462 patients (35.7%), grade I occurred in 335 (25.8%), grade II in 264 (20.5%), grade III in 110 (8.5%), and grade IV in 123 patients (9.5%). A total of 297 patients (23%) died within 100 days, 495 patients (38%) died of any TRM, and 100 patients (8%) died of relapse. D100M according to grades 0, I, II, III, and IV was 17%, 13%, 19%, 38%, and 70%, respectively, with significant difference between 0-II versus III-IV. TRM was 28%, 27%, 43%, 68%, and 92%, respectively, with a distinct separation between 0-I versus II-IV. RI showed a continuous decrease of 37%, 30%, 23%, 18%, and 8%, respectively, with increasing aGVHD. LFS was 45%, 51%, 44%, 26%, and 7%, respectively, and was best for patients with grade I aGVHD. This finding was also reflected in a better overall survival (60%, 64%, 53%, 30%, and 8%, respectively). The better LFS for grade I aGVHD patients compared with patients with grade 0 or II aGVHD was confirmed (P = .05) in a multivariate analysis. These data document the value of the present 5-point grading of aGVHD, ie, different outcome is observed depending on endpoint analyzed. Restricting information about aGVHD to presence or absence is not warranted.(C) 1995 by The American Society of Hematology.