Impact of graft-versus-host disease on outcomes after allogeneic hematopoietic cell transplantation for adult T-cell leukemia: a retrospective cohort study
Impact of graft-versus-host disease on outcomes after allogeneic hematopoietic cell transplantation for adult T-cell leukemia: a retrospective cohort study
复制标题
DOI：
10.1182/blood-2011-07-368233
复制
发表时间：
2012-03-01
期刊：
影响因子：
20.3
通讯作者：
Uchiyama, Takashi
中科院分区：
文献类型：
--
作者：
Kanda, Junya;Hishizawa, Masakatsu;Uchiyama, Takashi
异基因造血细胞移植（HCT）是治疗成人T细胞白血病（ATL）的一种有效方法，但移植物抗白血病效应在ATL中的作用仍存在疑问。在这项研究中，我们回顾性分析了急性和慢性移植物抗宿主病（GVHD）对294例接受同种异体HCT并在移植后至少存活30天且持续植入的ATL患者的总生存率、疾病相关死亡率和治疗相关死亡率的影响。将GVHD的发生作为随时间变化的协变量进行多变量分析，结果表明，与无急性GVHD相比，发生1-2级急性GVHD与较高的总生存率显著相关（死亡风险比[HR]为0.65; P = 0.018）。与无急性GVHD相比，发生1-2级或3-4级急性GVHD与较低的疾病相关死亡率相关，而3-4级急性GVHD与较高的治疗相关死亡率风险相关（HR，3.50; P < .001）。与无慢性GVHD相比，广泛慢性GVHD的发生与更高的治疗相关死亡率相关（HR，2.75; P = .006）。总的来说，这些结果表明，轻度至中度急性GVHD的发展赋予了较低的疾病进展的风险和有益的影响与ATL同种异体移植患者的生存。（血。2012; 119（9）：2141-2148）
Allogeneic hematopoietic cell transplantation (HCT) is an effective treatment for adult T-cell leukemia (ATL), raising the question about the role of graft-versus-leukemia effect against ATL. In this study, we retrospectively analyzed the effects of acute and chronic graft-versus-host disease (GVHD) on overall survival, disease-associated mortality, and treatment-related mortality among 294 ATL patients who received allogeneic HCT and survived at least 30 days posttransplant with sustained engraftment. Multivariate analyses treating the occurrence of GVHD as a time-varying covariate demonstrated that the development of grade 1-2 acute GVHD was significantly associated with higher overall survival (hazard ratio [HR] for death, 0.65; P = .018) compared with the absence of acute GVHD. Occurrence of either grade 1-2 or grade 3-4 acute GVHD was associated with lower disease-associated mortality compared with the absence of acute GVHD, whereas grade 3-4 acute GVHD was associated with a higher risk for treatment-related mortality (HR, 3.50; P < .001). The development of extensive chronic GVHD was associated with higher treatment-related mortality (HR, 2.75; P = .006) compared with the absence of chronic GVHD. Collectively, these results indicate that the development of mild-to-moderate acute GVHD confers a lower risk of disease progression and a beneficial influence on survival of allografted patients with ATL. (Blood. 2012; 119(9): 2141-2148)