GvHD after umbilical cord blood transplantation for acute leukemia: an analysis of risk factors and effect on outcomes.
GvHD after umbilical cord blood transplantation for acute leukemia: an analysis of risk factors and effect on outcomes.
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DOI：
10.1038/bmt.2016.265
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发表时间：
2017-03
影响因子：
4.8
通讯作者：
Cutler CS
中科院分区：
文献类型：
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作者：
Chen YB;Wang T;Hemmer MT;Brady C;Couriel DR;Alousi A;Pidala J;Urbano-Ispizua A;Choi SW;Nishihori T;Teshima T;Inamoto Y;Wirk B;Marks DI;Abdel-Azim H;Lehmann L;Yu L;Bitan M;Cairo MS;Qayed M;Salit R;Gale RP;Martino R;Jaglowski S;Bajel A;Savani B;Frangoul H;Lewis ID;Storek J;Askar M;Kharfan-Dabaja MA;Aljurf M;Ringden O;Reshef R;Olsson RF;Hashmi S;Seo S;Spitzer TR;MacMillan ML;Lazaryan A;Spellman SR;Arora M;Cutler CS
使用国际血液和骨髓移植研究中心（CIBMTR）登记处，我们分析了1，404例急性白血病UCBT患者[单次（< 18岁）= 810例，双次（≥ 18岁）= 594例]，以确定急性和慢性移植物vs.宿主疾病（GVHD），分析临床危险因素并调查结果。单次UCBT后，100天II-IV级aGVHD发生率为39%（95% CI，36-43%），III-IV级aGVHD为18%（95% CI，15-20%），1年cGVHD为27%（95% CI，24-30%）。双UCBT后，100天II-IV级aGVHD的发生率为45%（95% CI，41%-49%），III-IV级aGVHD为22%（95% CI，19-26%），1年cGVHD为26%（95% CI，22-29%）。对于单一UCBT，多变量分析显示，抗胸腺细胞球蛋白（ATG）的缺乏与aGVHD相关，而先前的aGVHD与cGVHD相关。对于双重UCBT，缺乏ATG和清髓性预处理与aGVHD相关，而先前的aGVHD预测cGVHD。III-IV级aGVHD导致更差的生存率，而cGVHD对无病生存率或总生存率无显著影响。UCBT后GVHD普遍存在，严重的aGVHD导致更高的死亡率。UCBT的未来研究应优先考虑GVHD的预防。
Using the Center for International Blood and Marrow Transplant Research (CIBMTR) registry, we analyzed 1,404 UCBT patients [single (< 18 years) = 810, double (≥ 18 years) = 594] with acute leukemia to define the incidence of acute and chronic graft-vs.-host disease (GVHD), analyze clinical risk factors and investigate outcomes. After single UCBT, 100-day incidence of grades II–IV aGVHD was 39% (95% CI, 36–43%), grades III–IV aGVHD was 18% (95% CI, 15–20%), and 1-year cGVHD was 27% (95% CI, 24–30%). After double UCBT, 100-day incidence of grades II–IV aGVHD was 45% (95% CI, 41%–49%), grades III–IV aGVHD was 22% (95% CI, 19–26%), and 1-year cGVHD was 26% (95% CI, 22–29%). For single UCBT, multivariate analysis showed that absence of anti-thymocyte globulin (ATG) was associated with aGVHD, whereas prior aGVHD was associated with cGVHD. For double UCBT, absence of ATG and myeloablative conditioning were associated with aGVHD, while prior aGVHD predicted for cGVHD. Grades III–IV aGVHD led to worse survival whereas cGVHD had no significant effect on disease-free or overall survival. GVHD is prevalent after UCBT with severe aGVHD leading to higher mortality. Future research in UCBT should prioritize prevention of GVHD.