A retrospective analysis of therapy for acute graft-versus-host disease: secondary treatment.
A retrospective analysis of therapy for acute graft-versus-host disease: secondary treatment.
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DOI：
10.1182/blood.v77.8.1821.1821
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发表时间：
1990-10
期刊：
影响因子：
20.3
通讯作者：
P. Martin;G. Schoch;L. D. Fisher;Vera Byers;C. Anasetti;F. Appelbaum;Patrick G. Beatty;K. Doney;George B. McDonald;J. Sanders;K. Sullivan;R. Storb;E. Thomas;R. Witherspoon;Pavel Lomen;John Hannigan;J. Hansen
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文献类型：
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作者：
P. Martin;G. Schoch;L. D. Fisher;Vera Byers;C. Anasetti;F. Appelbaum;Patrick G. Beatty;K. Doney;George B. McDonald;J. Sanders;K. Sullivan;R. Storb;E. Thomas;R. Witherspoon;Pavel Lomen;John Hannigan;J. Hansen
我们回顾了427例急性移植物抗宿主病(GVHD)患者的二次治疗结果，这些患者在一次治疗后没有持久的满意反应。在二次治疗开始时，320名患者(75%)出现皮疹，252名患者(59%)出现肝功能障碍，228名患者(53%)出现肠道功能障碍。糖皮质激素(249例)、环孢素(80例)、抗胸腺细胞球蛋白(114例)或单抗(19例)单独治疗390例，联合治疗37例。每周记录GVHD严重程度的参数，并根据第三次治疗开始时的值或对于未接受第三次治疗的患者，使用第二次治疗第29天的值或死亡前最后记录的值(以先发生的为准)确定反应。为每个器官定义了改善或恶化的最低标准，但如果存在其他并发症，如静脉闭塞疾病或感染性肠炎，则没有尝试定义肝脏或肠道结果。45%的皮肤病患者、25%的可评估的肝病患者和35%的可评估的肠道疾病患者的相应器官移植物抗宿主病得到改善或缓解。40%的患者总体完全或部分缓解。二次治疗的完全应答率最高(23%)，当GVHD在初级糖皮质激素治疗的逐渐减少阶段复发时，并通过增加糖皮质激素剂量来控制。进行多变量分析以确定与完全缓解或总体改善的可能性相关的患者、疾病或治疗因素。进行了类似的分析，以确定与治疗失败时间相关的协变量(定义为开始第三次治疗或死亡不是由于恶性肿瘤复发)。治疗开始时皮肤、肝脏和肠道的严重功能障碍与完全应答的可能性降低和治疗失败率增加有关。初次治疗和二次治疗中，治疗失败的时间和不同反应类别的患者比例相似，这表明可以有意义地评估新的免疫抑制剂治疗急性GVHD的潜在疗效，这些患者对初次治疗没有足够的反应。
We have reviewed results of secondary therapy in 427 patients with acute graft-versus-host disease (GVHD) who did not have a durable satisfactory response after primary treatment. At the beginning of secondary treatment, 320 patients (75%) had rash, 252 (59%) had liver dysfunction, and 228 (53%) had gut dysfunction. Secondary treatment was with glucocorticoids (n = 249), cyclosporine (n = 80), antithymocyte globulin (n = 114), or monoclonal antibody (n = 19) either singly (n = 390) or in combination (n = 37). Parameters of GVHD severity were recorded weekly, and responses were determined according to values at the initiation of tertiary treatment or, for patients without such treatment, using values on day 29 of secondary treatment or the last recorded values before death, whichever occurred first. Minimal criteria for improvement or deterioration were defined for each organ, but no attempt was made to define liver or gut outcome if another complication such as venocclusive disease or infectious enteritis was present. Improvement or resolution of GVHD in the respective organ was seen in 45% of patients with skin disease, 25% of patients with evaluable liver disease, and in 35% of patients with evaluable gut disease. Overall complete or partial responses were seen in 40% of patients. The highest complete response rate with secondary therapy (23%) was seen when GVHD recurred during the taper phase of primary glucocorticoid treatment and was managed by increasing the dose of glucocorticoids. Multivariate analyses were performed to identify patient, disease, or treatment factors associated with likelihood of complete response or overall improvement. A similar analysis was performed to identify covariates associated with time to treatment failure (defined as initiation of tertiary therapy or death not due to relapse of malignancy). Severe dysfunction in the skin, liver, and gut at the beginning of treatment was associated both with a decreased likelihood of complete response and an increased treatment failure rate. The times to treatment failure and the proportions of patients in various response categories were similar for primary and secondary treatment, suggesting that the potential efficacy of new immunosuppressive agents for treatment of acute GVHD can be assessed meaningfully in patients who have not responded adequately to initial therapy.