Late Acute and Chronic Graft-versus-Host Disease after Allogeneic Hematopoietic Cell Transplantation.
Late Acute and Chronic Graft-versus-Host Disease after Allogeneic Hematopoietic Cell Transplantation.
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DOI：
10.1016/j.bbmt.2015.10.018
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发表时间：
2016-03
期刊：
影响因子：
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通讯作者：
Lee SJ
中科院分区：
文献类型：
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作者：
Arora M;Cutler CS;Jagasia MH;Pidala J;Chai X;Martin PJ;Flowers ME;Inamoto Y;Chen GL;Wood WA;Khera N;Palmer J;Duong H;Arai S;Mayer S;Pusic I;Lee SJ
几种不同的移植物抗宿主病（GVHD）相关综合征已经由NIH共识会议定义。我们在2011年3月至2014年5月期间在13个中心招募了911名造血细胞移植（HCT）接受者的前瞻性队列，以评估四种GVHD综合征：晚期急性GVHD、慢性GVHD、闭塞性细支气管炎综合征和皮肤硬化。HCT的中位年龄为53.7岁。大多数患者接受外周血干细胞移植（81%），使用非清髓性或降低强度调节（55%）。在我们的队列中，儿童年龄组和骨髓和脐带血的使用代表性不足（<=11%）。晚期急性GVHD（迟发和复发）的累积发病率为10%，中位时间为5.5个月，慢性GVHD为47%，中位时间为7.4个月，闭塞性细支炎为3%，中位时间为12.2个月，皮肤硬化症为8%，中位时间为14.0个月。晚期急性GVHD和闭塞性细支气管炎在诊断后2年的非复发死亡率特别高，分别为23%和32%。晚期急性和慢性gvhd无复发生存率在HCT后1年和2年分别为38%和26%。这项多中心的前瞻性研究证实了晚期急性和慢性GVHD综合征的高发生率，并支持持续密切监测和开发更有效的GVHD治疗策略以提高HCT成功率的必要性。
Several distinct graft-versus-host disease (GVHD)-related syndromes have been defined by the NIH Consensus Conference. We enrolled a prospective cohort of 911 hematopoietic cell transplantation (HCT) recipients at 13 centers between March 2011 and May 2014 to evaluate four GVHD syndromes: late acute GVHD, chronic GVHD, bronchiolitis obliterans syndrome, and cutaneous sclerosis. The median age at HCT was 53.7 years. Most patients received peripheral blood stem cell transplant (81%) using a non myeloablative or reduced intensity conditioning (55%). Pediatric age group and use of bone marrow and umbilical cord blood were underrepresented in our cohort (<=11%). The cumulative incidence of late acute GVHD (late onset and recurrent) was 10% at a median of 5.5 months, chronic GVHD was 47% at a median of 7.4 months, bronchiolitis obliterans was 3% at a median of 12.2 months, and cutaneous sclerosis was 8% at a median onset of 14.0 months after HCT. Late acute GVHD and bronchiolitis obliterans had particularly high non-relapse mortality of 23% and 32% by 2 years after diagnosis. The probability of late acute- and chronic-GVHD-free, relapse-free survival at one and two years after HCT was 38% and 26%. This multi-center, prospective study confirms the high rate of late acute and chronic GVHD syndromes and supports the need for continuous close monitoring and development of more effective GVHD treatment strategies to improve HCT success.