An analysis of the effect of chronic GvHD on relapse and survival following allogeneic PBSC transplantation
An analysis of the effect of chronic GvHD on relapse and survival following allogeneic PBSC transplantation
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DOI：
10.1080/146532400539369
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发表时间：
2000-01-01
期刊：
影响因子：
4.5
通讯作者：
Bell, A
中科院分区：
文献类型：
--
作者：
Miflin, G;Russell, NH;Bell, A
pbsc越来越多地被用作同种异体移植的干细胞来源。然而，未经处理的同种异体造血干细胞移植（PBSCT）后，慢性GvHD的发病率增加；这对总体生存率的影响尚不清楚。我们的目的是研究慢性GvHD对同种异体PBSCT后生存和复发的影响。方法我们分析了73例接受hla匹配的同种异体PBSCT患者的数据。97%的GvHD患者使用CYA和MTX进行预防。我们研究了慢性GvHD的发病率及其对这些患者复发和生存的影响。所有患者在移植后至少100天进行分析。结果73例患者可用于慢性GvHD分析。慢性GvHD的总发病率为55%（局限性为18%，广泛性为37%）。总中位生存期为991天，4年生存率为48%。12例慢性GvHD患者的疾病复发发生率显著降低（p = 0.005）， 3年复发概率为8%，而非慢性GvHD患者的复发概率为40%。此外，慢性GvHD的程度对生存有显著影响，有限慢性GvHD患者的4年生存率为83%，而广泛慢性GvHD患者为45%，无慢性GvHD患者为38%。这种差异主要是由于有限慢性GvHD患者的复发率低，死亡率低。慢性GvHD的存在和程度是异基因PBSCT后预后的重要预测因素，因为发生有限或广泛慢性GvHD的患者复发的风险较低。
BackgroundPBSC are increasingly being used as the source of stem cells in allogeneic transplantation. An increased incidence of chronic GvHD has been suggested following unmanipulated, allogeneic PBSC transplantation (PBSCT), however; how this affects overall survival is not yet clear. Our aim was to study the impact of chronic GvHD on survival and relapse following allogeneic PBSCT.MethodsWe have analyzed data from 73 patients undergoing HLA-matched allogeneic PBSCT. GvHD prophylaxis was with CYA and MTX in 97% of patients. We have studied the incidence of chronic GvHD and its affect on relapse and survival in these patients. All patients were at least 100 days post-transplant at the time a analysis.ResultsSeventy-three patients were evaluable for analysis of chronic GvHD. The overall incidence a chronic GvHD was 55% (limited in 18% and extensive in 37%). Overall median survival was 991 days, with a 4year survival rate of 48%. Twelve patients relapsed Patients with chronic GvHD had a significantly lower incidence of disease relapse (p = 0.005) with a relapse probability of 8% at 3 years compared with 40% in patients with no chronic GvHD. In addition, the extent of chronic GvHD had a marked effect on survival patients with limited chronic GvHD had a 4 year survival rate of 83%, compared with 45% in patients with extensive chronic GvHD and 38% in patients with no chronic GvHD. This difference was primarily due to the low incidence of relapse and low mortality seen in patients with limited chronic GvHD.DiscussionThe presence and extent a chronic GvHD is an important predictor of outcome following allogeneic PBSCT, in that patients who developed either limited or extensive chronic GvHD had a low risk a disease relapse.