Acute and chronic Graft-versus-Host disease after ablative and nonmyeloablative conditioning for allogeneic hematopoietic transplantation
Acute and chronic Graft-versus-Host disease after ablative and nonmyeloablative conditioning for allogeneic hematopoietic transplantation
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DOI：
10.1016/j.bbmt.2003.10.006
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发表时间：
2004-03-01
影响因子：
4.3
通讯作者：
Champlin, R
中科院分区：
文献类型：
--
作者：
Couriel, DR;Saliba, RM;Champlin, R
在这项研究中，我们评估了非清髓性和清髓性预处理方案对急性和慢性移植物抗宿主病（GVHD）发生的影响。137例接受匹配相关同胞移植的患者接受了相同的GVHD预防。清髓方案包括静脉注射白消安/环磷酰胺（n = 45）和氟达拉滨/美法仑（n = 29）。非清髓性组（n = 63）患者接受氟达拉滨/伊达比星/阿糖胞苷、顺铂/氟达拉滨/伊达比星和氟达拉滨/环磷酰胺治疗。与非清髓性组（12%）相比，接受清髓性方案的患者（36%）11级至IV级急性GVHD的精算率显著更高（风险比，3.6; 95%置信区间，1.5-8.8）。慢性GVHD的累积发生率在清髓性组（40%）高于非清髓性组（14%）。前200天内的发生率相当，200天后消融组的发生率显著较高（风险比，5.2; 95%置信区间，1.2-23.2）。两组的非复发和GVHD相关死亡率相对较低。与白消安/环磷酰胺和氟达拉滨/美法仑移植方案相比，使用所述非清髓性准备方案与H至IV级急性GVHD和慢性GVHD的发生率降低相关。值得注意的是，非清髓性方案在老年和体弱患者中的非复发死亡率较低（14%），与标准高剂量方案在年轻患者中的非复发死亡率相当。(C)2004年美国血液和骨髓移植学会。
In this study, we evaluated the influence of nonmyeloablative and ablative conditioning regimens on the occurrence of acute and chronic graft-versus-host disease (GVHD). One hundred thirty-seven patients undergoing matched-related sibling transplantations received the same GVHD prophylaxis. Myeloablative regimens included intravenous busulfan/cyclophosphamide (n = 45) and fludarabine/melphalan (n = 29). Patients in the nonmyeloablative group (n = 63) received fludarabine/idarubicin/cytarabine, cisplatin/fludarabine/idarubicin, and fludarabine/cyclophosphamide. The actuarial rate of grade 11 to IV acute GVHD was significantly higher (hazard ratio, 3.6; 95% confidence interval, 1.5-8.8) in patients receiving ablative regimens (36%) compared with the nonmyeloablative group (12%). The cumulative incidence of chronic GVHD was higher in the ablative group (40%) compared with the nonmyeloablative group (14%). The rates were comparable within the first 200 days and were significantly higher in the ablative group beyond day 200 (hazard ratio, 5.2; 95% confidence interval, 1.2-23.2). Nonrelapse and GVHD-related mortality were relatively low in both groups. The use of the described nonmyeloablative preparative regimens was associated with a reduced incidence of grade H to IV acute GVHD and chronic GVHD compared with the busulfan/cyclophosphamide and fludarabine/melphalan transplant regimens. It is interesting to note that nonrelapse mortality with nonmyeloablative regimens in older and more debilitated patients was low (14%) and comparable to that achieved with standard high-dose regimens in younger patients. (C) 2004 American Society for Blood and Marrow Transplantation.