Chronic graft-versus-host disease after allogeneic blood stem cell transplantation
Chronic graft-versus-host disease after allogeneic blood stem cell transplantation
复制标题
DOI：
10.1182/blood.v98.6.1695
复制
发表时间：
2001-09-15
期刊：
影响因子：
20.3
通讯作者：
Champlin, R
中科院分区：
文献类型：
--
作者：
Przepiorka, D;Anderlini, P;Champlin, R
在连续的116例HLA相合造血干细胞移植受者中评价慢性移植物抗宿主病（GVHD）的发生率、特征、危险因素和影响。最短随访时间为18个月。有限慢性GVHD发生率为6%（95%置信区间[CI]，0%-13%），临床广泛慢性GVHD发生率为71%（95% CI，61%-80%）。累积发生率为57%（95% CI，48%-66%）。在单变量分析中，除他克莫司和甲氨蝶呤以外的GVHD预防、既往2 - 4级急性GVHD、第100天使用皮质类固醇和总有核细胞剂量是临床广泛慢性GVHD的显著危险因素。在多变量分析中，他克莫司和甲氨蝶呤预防GVHD与慢性GVHD风险降低相关（风险比[HR]，0.35; P = 0.001），而既往急性GVHD风险增加（HR，1.67; P = 0.046）。当调整移植时的疾病状态时，高危慢性GVHD对18个月时的总死亡率（HR，6.6; P < .001）和治疗失败（HR，5.2; P < .001）有不利影响。结论：HLA相合的异基因造血干细胞移植后慢性GVHD的发生率很高，临床因素可能改变慢性GVHD的风险，高风险慢性GVHD会对结局产生不利影响。(C)2001年，美国血液学会。
The incidence, characteristics, risk factors for, and impact of chronic graft-vs-host disease (GVHD) were evaluated in a consecutive series of 116 evaluable HLA-identical blood stem cell transplant recipients. Minimum follow-up was 18 months. Limited chronic GVHD occurred in 6% (95% confidence interval [CI], 0%-13%), and clinical extensive chronic GVHD in 71% (95% CI, 61%-80%). The cumulative incidence was 57% (95% CI, 48%-66%). In univariate analyses, GVHD prophylaxis other than tacrolimus and methotrexate, prior grades 2 to 4 acute GVHD, use of corticosteroids on day 100, and total nucleated cell dose were significant risk factors for clinical extensive chronic GVHD. On multivariate analysis, GVHD prophylaxis with tacrolimus and methotrexate was associated with a reduced risk of chronic GVHD (hazard ratio [HR], 0.35; P = .001), whereas the risk was increased with prior acute GVHD (HR, 1.67; P = .046). When adjusted for disease status at the time of transplantation, high-risk chronic GVHD had an adverse impact on overall mortality (HR, 6.6; P < .001) and treatment failure (HR, 5.2; P < .001) at 18 months. It was concluded that there is a substantial rate of chronic GVHD after HLA-identical allogeneic blood stem cell transplantation, that clinical factors may alter the risk of chronic GVHD, and that high-risk chronic GVHD adversely affects outcome. (C) 2001 by The American Society of Hematology.