Przepiorka D, Smith T L, Folloder J, Khouri I, Ueno N T, Mehra R, Körbling M, Huh Y O, Giralt S, Gajewski J, Donato M, Cleary K, Claxton D, Braunschweig I, van Besien K, Andersson B S, Anderlini P, Champlin R
Departments of Blood and Marrow Transplantation, Biomathematics, Laboratory Medicine and Pathology, University of Texas M.D. Anderson Cancer Center, Houston, TX, USA.
Blood. 1999 Aug 15;94(4):1465-70.
We evaluated demographic characteristics and graft composition as risk factors for acute graft-versus-host disease (GVHD) in 160 adult recipients of HLA-identical allogeneic blood stem cell transplants. The patients received a median nucleated cell dose of 7.9 x 10(8)/kg and median C34(+) cell dose of 5.6 x 10(6)/kg. GVHD prophylaxis consisted of cyclosporine (CSA) and steroids, tacrolimus (FK506) and steroids, or FK506 and methotrexate. Grades 2 to 4 GVHD occurred in 31% (95% CI, 23% to 39%), and grades 3 to 4 GVHD in 14% (95% CI, 8% to 20%). In univariate analyses, GVHD prophylaxis with CSA and high CD34(+) cell doses were significant risk factors for grades 2 to 4 GVHD, but diagnosis, age, use of total body irradiation, donor sex, female donor for male recipient, donor parity, donor alloimmunization, viral serology, nucleated cell dose, CD3(+) cell dose, and CD56(+) cell dose did not alter the incidence of GVHD significantly. With a CD34(+) cell dose less than 8 x 10(6) CD34(+) cells/kg, the risk of grades 2 to 4 GVHD was significantly higher for those who received CSA (39%, 95% CI, 21% to 47%) in comparison with those on FK506 (18%, 95% CI, 10% to 26%) (P =.03), but GVHD prophylaxis regimen had less impact with a higher CD34(+) cell dose (overall grades 2 to 4 GVHD rate 52%, 95% CI, 37% to 67%). GVHD prophylaxis and CD34(+) cell dose are independent risk factors for acute GVHD after allogeneic blood stem cell transplantation.
我们评估了160例接受 HLA 同基因异基因造血干细胞移植的成年受者的人口统计学特征和移植物组成，将其作为急性移植物抗宿主病（GVHD）的危险因素。患者接受的有核细胞剂量中位数为7.9×10⁸/kg，C34⁺细胞剂量中位数为5.6×10⁶/kg。GVHD预防方案包括环孢素（CSA）和类固醇、他克莫司（FK506）和类固醇，或FK506和甲氨蝶呤。2至4级GVHD发生率为31%（95%CI，23%至39%），3至4级GVHD发生率为14%（95%CI，8%至20%）。在单因素分析中，CSA预防GVHD和高CD34⁺细胞剂量是2至4级GVHD的显著危险因素，但诊断、年龄、全身照射的使用、供者性别、男性受者的女性供者、供者产次、供者同种免疫、病毒血清学、有核细胞剂量、CD3⁺细胞剂量和CD56⁺细胞剂量对GVHD发生率无显著影响。当CD34⁺细胞剂量低于8×10⁶个CD34⁺细胞/kg时，接受CSA的患者发生2至4级GVHD的风险（39%，95%CI，21%至47%）显著高于接受FK506的患者（18%，95%CI，10%至26%）（P = 0.03），但CD34⁺细胞剂量较高时，GVHD预防方案的影响较小（总体2至4级GVHD发生率为52%，95%CI，37%至67%）。GVHD预防方案和CD34⁺细胞剂量是异基因造血干细胞移植后急性GVHD的独立危险因素。
