Reduced intensity conditioning increases risk of severe cGVHD: identification of risk factors for cGVHD in a multicenter setting.
Reduced intensity conditioning increases risk of severe cGVHD: identification of risk factors for cGVHD in a multicenter setting.
复制标题
DOI：
10.1007/s12032-018-1127-2
复制
发表时间：
2018-04-25
期刊：
影响因子：
--
通讯作者：
Hägglund H
中科院分区：
文献类型：
--
作者：
Afram G;Simón JAP;Remberger M;Caballero-Velázquez T;Martino R;Piñana JL;Ringden O;Esquirol A;Lopez-Corral L;Garcia I;López-Godino O;Sierra J;Caballero D;Ljungman P;Vazquez L;Hägglund H
慢性移植物抗宿主病（cGVHD）仍然是异体造血干细胞移植（HSCT）后发病和死亡的主要原因。目的是在多中心环境中确定cGVHD发展的危险因素。分析了2000年至2006年间移植的患者（n = 820）。献血者为hla相同的兄弟姐妹（57%），匹配的非亲属献血者（30%）和HLA-A， B或DR抗原不匹配（13%）。65%的患者接受降低强度调节（RIC）治疗。在移植后存活超过100天的患者中，cGVHD的总发生率为46% （n = 747）。老年患者年龄[HR 1.15, p < 0.001]、既往急性GVHD [1.30, p = 0.024]和RIC [1.36, p = 0.028]增加了总体cGVHD。此外，RIC [4.85, p < 0.001]、既往aGVHD [2.14, p = 0.001]和女性供体对男性受体[1.80,p = 0.008]增加了严重cGVHD的风险。ATG对总体[0.41,p < 0.001]和重度cGVHD [0.20, p < 0.001]均有保护作用。严重cGVHD患者的无复发生存期（RFS）受损。RIC、既往aGVHD和女性对男性的捐赠增加了严重cGVHD的风险。ATG降低了所有级别cGVHD的风险，而不妨碍RFS。GVHD预防可以根据患者的风险概况量身定制。
Chronic graft-versus-host disease (cGVHD) remains a major cause of morbidity and mortality after allogeneic hematopoietic stem cell transplantation (HSCT). Aim is to identify risk factors for the development of cGVHD in a multicenter setting. Patients transplanted between 2000 and 2006 were analyzed (n = 820). Donors were HLA-identical siblings (57%), matched unrelated donors (30%), and HLA-A, B or DR antigen mismatched (13%). Reduced intensity conditioning (RIC) was given to 65% of patients. Overall incidence of cGVHD was 46% for patients surviving more than 100 days after HSCT (n = 747). Older patient age [HR 1.15, p < 0.001], prior acute GVHD [1.30, p = 0.024], and RIC [1.36, p = 0.028] increased overall cGVHD. In addition, RIC [4.85, p < 0.001], prior aGVHD [2.14, p = 0.001] and female donor to male recipient [1.80, p = 0.008] increased the risk of severe cGVHD. ATG had a protective effect for both overall [0.41, p < 0.001] and severe cGVHD [0.20, p < 0.001]. Relapse-free survival (RFS) was impaired in patients with severe cGVHD. RIC, prior aGVHD, and female-to-male donation increase the risk of severe cGVHD. ATG reduces the risk of all grades of cGVHD without hampering RFS. GVHD prophylaxis may be tailored according to the risk profile of patients.
登录
查看更多内容
影响因子：
20.3
作者：
Inamoto, Yoshihiro;Storer, Barry E.;Martin, Paul J.
通讯作者：
Martin, Paul J.
影响因子：
20.3
作者：
Soiffer, Robert J.;LeRademacher, Jennifer;Eapen, Mary
通讯作者：
Eapen, Mary
影响因子：
51.1
作者：
Finke, Juergen;Bethge, Wolfgang A.;Socie, Gerard
通讯作者：
Socie, Gerard
影响因子：
2.1
作者：
Remberger, Mats;Ringden, Olle;Mattsson, Jonas
通讯作者：
Mattsson, Jonas
影响因子：
4.3
作者：
Couriel, DR;Saliba, RM;Champlin, R
通讯作者：
Champlin, R