Chronic graft-versus-host disease (cGVHD) following unrelated donor hematopoietic stem cell transplantation (HSCT): Higher response rate in recipients of unrelated donor (URD) umbilical cord blood (UCB)
Chronic graft-versus-host disease (cGVHD) following unrelated donor hematopoietic stem cell transplantation (HSCT): Higher response rate in recipients of unrelated donor (URD) umbilical cord blood (UCB)
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DOI：
10.1016/j.bbmt.2007.06.004
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发表时间：
2007-10-01
影响因子：
4.3
通讯作者：
Weisdof, Daniel J.
中科院分区：
文献类型：
--
作者：
Arora, Mukta;Nagaraj, Sriharsha;Weisdof, Daniel J.
我们报告了170例慢性移植物抗宿主病(CGVHD)患者的临床表现和治疗反应的对比分析(123例来自无关供者[URD]和47例来自脐带血[UCB])。URD移植受者明显更年轻(中位年龄25岁对39岁，P=.002；供者移植物大多是人类白细胞抗原相合的(67%对10%，P<；.0001))。接受UCB治疗的患者对治疗的反应(完全缓解[CR]+部分缓解[PR])更频繁(2个月URD为48%，UCB为74%[P=.005]；6个月为49%，UCB为78%[P=.001]；1年为51%，UCB为72%[P=.031]。诊断为慢性移植物抗宿主病(CGVHD)的无复发死亡率(NRM)在URD移植后较差。(1年NRM 27%[19%-35%]URD与11%[2%-20%]UCB，P=.055)。在每个队列中进行了单独的多变量分析。在这两组患者中，血小板减少和2个月后无CR或PR独立地与死亡率增加相关。此外，慢性移植物抗宿主病的进行性发作是URD队列中死亡率增加的重要预测因素。这些数据表明，脐带血移植后的cGVHD可能对治疗更敏感，也会导致较低的NRM。(C)2007年美国血液和骨髓移植学会。
We present a comparative analysis of clinical presentation and response to treatment in 170 patients with chronic graft versus host disease (cGVHD) (123 following transplant from an unrelated donor [URD] and 47 from umbilical cord blood [UCB]). URD transplant recipients were significantly younger (median age 25 versus 39 years, P = .002; and the donor grafts were mostly HLA matched (67% versus 10%, P < .0001). UCB recipients had more frequent responses (complete remission [CR] + partial remission [PR]) to treatment (URD 48% versus UCB 74% at 2 months [P = .005]; 49% versus 78% at 6 months [P = .001] and 51% versus 72% at 1 year [P = .031 in the URD and UCB groups, respectively). Nonrelapse mortality (NRM) after diagnosis of cGVHD was worse after URD grafts. (1 year NRM 27% [19%-35%] URD versus 11% [2%-20%] UCB, P = .055). Separate multivariate analyses were performed in each cohort. In both, thrombocytopenia and no CR or PR at 2 months were independently associated with increased mortality. In addition, progressive onset of cGVHD was a significant predictor of increased mortality in URD cohort. These data suggest that cGVHD following UCB transplant may be more responsive to therapy and also lead to a lower NRM. (C) 2007 American Society for Blood and Marrow Transplantation.