CLINICAL MANIFESTATIONS OF GRAFT VERSUS HOST DISEASE IN HUMAN RECIPIENTS OF MARROW FROM HL-A-MATCHED SIBLING DONORS
CLINICAL MANIFESTATIONS OF GRAFT VERSUS HOST DISEASE IN HUMAN RECIPIENTS OF MARROW FROM HL-A-MATCHED SIBLING DONORS
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DOI：
10.1097/00007890-197410000-00001
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发表时间：
1974-01-01
期刊：
影响因子：
6.2
通讯作者：
THOMAS, ED
中科院分区：
文献类型：
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作者：
GLUCKSBERG, H;STORB, R;THOMAS, ED
61例可评价患者，19例晚期再生障碍性贫血和42例终末期恶性血液病，接受全身照射或环磷酰胺或两者联合的骨髓移植。骨髓移植供体是在HL-A区匹配的同胞，在混合白细胞培养中无反应。所有患者均在移植后接受甲氨蝶呤治疗，以改善预期的移植物抗宿主病（GVHD）。61例患者中有43例发生临床可识别的GVHD。7例GVHD仅限于皮肤。在其余患者中，皮肤受累更严重，其次是胃肠道受累，表现为厌食、恶心、腹泻、腹痛和吸收不良，和/或肝脏受累，表现为肝肿大、血清谷草转氨酶和胆红素升高。GVHD的严重程度与基础疾病、预处理方案或移植后发病日期无关。25例无GVHD或仅皮肤受累的患者中有14例存活。相比之下，36例严重GVHD患者中只有5例存活。36例严重GVHD患者中有26例死于感染，而25例无GVHD或仅皮肤受累的患者中只有4例死于感染。结果表明，尽管组织相容性匹配和甲氨蝶呤治疗，移植物抗宿主病仍然是一个严重的，往往是致命的并发症骨髓移植。
Sixty-one evaluable patients, 19 with advanced aplastic anemia and 42 with end stage hematological malignancies, were conditioned for marrow grafting with total body irradiation or cyclophosphamide, or a combination of both. Marrow graft donors were siblings matched at the HL-A region and nonreactive in mixed leukocyte culture. All patients received methotrexate postgrafting to modify anticipated graft-versus-host disease (GVHD). Forty-three of the 61 patients developed clinically recognizable GVHD. In seven GVHD was limited to the skin. In the remaining patients, skin involvement was more severe and was followed by gastrointestinal involvement manifested by anorexia, nausea, diarrhea, abdominal pain, and malabsorption and/or liver involvement manifested by hepatomegaly, rises in serum glutamic oxaloacetic acid transaminase, and bilirubin. The severity of GVHD showed no correlation with the underlying disease, the conditioning regimen, or the day of onset after grafting. Fourteen of 25 patients without GVHD or with only skin involvement are alive. By contrast, only 5 of 36 with severe GVHD are alive. Twenty-six of the 36 patients with severe GVHD succumbed to infection, whereas only 4 of 25 without GVHD or with only skin involvement did so. The results show that despite histocompatibility matching and methotrexate therapy, GVHD remains a serious and often fatal complication of marrow transplantation.