Risk-factor analysis for predicting progressive- or quiescent-type chronic graft-versus-host disease in a patient cohort with a history of acute graft-versus-host disease after allogeneic stem cell transplantation
Risk-factor analysis for predicting progressive- or quiescent-type chronic graft-versus-host disease in a patient cohort with a history of acute graft-versus-host disease after allogeneic stem cell transplantation
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DOI：
10.1038/sj.bmt.1705313
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发表时间：
2006-04
影响因子：
4.8
通讯作者：
Sk Sohn;DH Kim;Jh Baek;JG Kim;KB Lee;K. Lee;J. Lee;S. Choi;I. Shin
中科院分区：
文献类型：
--
作者：
Sk Sohn;DH Kim;Jh Baek;JG Kim;KB Lee;K. Lee;J. Lee;S. Choi;I. Shin
本研究试图确定变量，可以预测进展型或静止型慢性GVHD（pq cGVHD）的发展和移植后的结果诊断cGVHD后，99例患者发生急性GVHD（aGVHD）异基因SCT。研究了各种临床参数在诊断cGVHD时的预后意义，以确定pq cGVHD患者GVHD特异性生存期（GSS）的预后因素。在118例发生任何程度aGVHD的患者中，99例进行了cGVHD评估。2年时总体和广泛pq cGVHD的发生率估计分别为84.4%和63.1%。多因素分析显示，重度aGVHD（3、4级）（P= 0.022）、初次治疗失败（P= 0.009）和碱性磷酸酶升高（P= 0.001）均为预测pq cGVHD总体发生率较高的显著独立因素。诊断cGVHD后2年的GSS和全身免疫抑制治疗的概率估计为55.9%和51.9%。通过考克斯比例风险模型，GVHD特异性存活率与诊断cGVHD时的体力状态（P= 0.004）和淋巴细胞减少（> 1000/μl，P= 0.022）显著相关。严重aGVHD、原发性治疗失败（PTF）、淋巴细胞减少和碱性磷酸酶升高可能是异基因SCT后发生aGVHD患者发生pq cGVHD的有用预测因素。
This study attempts to identify variables that can predict the development of progressive-or quiescent-type chronic GVHD (pq cGVHD) and transplant outcomes after the diagnosis of cGVHD in 99 patients who experienced acute GVHD (aGVHD) after allogeneic SCT. The prognostic significance of various clinical parameters at diagnosis of cGVHD was examined to determine the prognostic factors for GVHD-specific survival (GSS) in patients with pq cGVHD. Among 118 patients who experienced any degree of aGVHD, 99 were evaluated for cGVHD. The incidence of overall and extensive pq cGVHD at 2 years was estimated as 84.4 and 63.1%, respectively. A multivariate analysis showed that severe aGVHD (grade 3, 4)(P= 0.022), primary treatment failure (P= 0.009) and elevated alkaline phosphatase (P= 0.001) were all significant independent factors predicting a higher overall incidence of pq cGVHD. The GSS and probability of systemic immunosuppressive treatment at 2 years after diagnosis of cGVHD were estimated as 55.9 and 51.9%. GVHD-specific survival was significantly associated with performance status (P= 0.004) and lymphocytopenia (⩽ 1000/μl, P= 0.022) at diagnosis of cGVHD by Cox's proportional hazard model. Severe aGVHD, primary treatment failure (PTF), lymphocytopenia and elevated alkaline phosphatase may be useful predictive factors for the development of pq cGVHD in patients who experience aGVHD after allogeneic SCT.