Impact of graft-versus-host disease on the clinical outcome of allogeneic hematopoietic stem cell transplantation for non-malignant diseases
Impact of graft-versus-host disease on the clinical outcome of allogeneic hematopoietic stem cell transplantation for non-malignant diseases
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DOI：
10.1007/s12185-020-02839-4
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发表时间：
2020-02-12
影响因子：
2.1
通讯作者：
Morio, Tomohiro
中科院分区：
文献类型：
--
作者：
Umeda, Katsutsugu;Imai, Kohsuke;Morio, Tomohiro
回顾性分析了960例首次异基因造血干细胞移植（HSCT）的非恶性疾病（NMD）患者的急性和慢性移植物抗宿主病（GVHD）对临床结局的影响。III-IV级急性GVHD（而不是I-II级）与较低的总生存率（OS）和较高的非复发死亡率（NRM）显著相关，而不是在没有急性GVHD的患者中观察到。与无慢性GVHD的患者相比，广泛（但不限于）GVHD与OS率较低和NRM较高显著相关。任何级别的急性（而非慢性）GVHD与复发率较低以及因移植物衰竭或混合嵌合体需要第二次HSCT或供体淋巴细胞输注的患者比例较低显著相关，但其对OS的影响几乎可以忽略不计。急性GVHD在所有疾病组中与较低的OS率显著相关，而慢性GVHD在原发性免疫缺陷和组织细胞增多症组中与较低的OS率显著相关。总之，急性和慢性GVHD，即使是轻微的，与接受HSCT治疗NMD的患者的OS降低相关，因此，应实施有效的策略以尽量减少GVHD。
The impact of acute and chronic graft-versus-host disease (GVHD) on clinical outcomes was retrospectively analyzed in 960 patients with non-malignant diseases (NMD) who underwent a first allogeneic hematopoietic stem cell transplantation (HSCT). Grade III-IV acute GVHD (but not grade I-II) was significantly associated with a lower rate of overall survival (OS), and higher non-relapse mortality (NRM) than that seen in patients without acute GVHD. Extensive (but not limited) GVHD was significantly associated with a lower OS rate and higher NRM than that seen in patients without chronic GVHD. Any grade of acute (but not chronic) GVHD was significantly associated with a lower incidence of relapse and a lower proportion of patients requiring a second HSCT or donor lymphocyte infusion for graft failure or mixed chimerism, but its impact on OS was almost negligible. Acute GVHD was significantly associated with lower OS rates in all disease groups, whereas chronic GVHD was significantly associated with lower OS rates in the primary immunodeficiency and histiocytosis groups. In conclusion, acute and chronic GVHD, even if mild, was associated with reduced OS in patients receiving HSCT for NMD and effective strategies should, therefore, be implemented to minimize GVHD.