Kim D H, Sohn S K, Kim J G, Suh J S, Lee K S, Lee K B
Department of Hematology/Oncology, Kyungpook National University Hospital, 50 Samduk 2-Ga, Jung-Gu, Daegu 700-721, Korea.
Bone Marrow Transplant. 2004 May;33(10):1025-30. doi: 10.1038/sj.bmt.1704479.
The current study defines the incidence and clinical manifestations of hyperacute graft-versus-host disease (haGVHD; fever, skin rash, diarrhea, and hepatic dysfunction) and analyzes the risk factor and the impact of haGVHD on the results of allogeneic stem cell transplantation (SCT). In all, 90 patients underwent allogeneic SCT from 71 matched siblings or 19 alternative donors. Immediate high-dose steroids were administered to 22 patients who met the criteria. The overall incidence of haGVHD was 36.7% (n=34) and haGVHD was also strongly correlated with acute (aGVHD) (P<0.001) and extensive chronic GVHD (cGVHD) (P=0.007), and found to be associated with decreased probability of relapse (P=0.0017). Early intervention with steroids within 7 days after the diagnosis of haGVHD might be associated with better survival. A survival analysis of the overall survival and disease-free survival did not reveal any difference between haGVHD+ and haGVHD- groups. In multivariate analysis, the use of an alternative donor (P=0.020) was identified as the only risk factor. Immediate high-dose steroids were effective in treating haGVHD. We conclude that in an allogeneic setting, haGVHD is not an uncommon manifestation, associated with the development of aGVHD or cGVHD. The only risk factor for haGVHD was the use of an alternative donor.
本研究定义了超急性移植物抗宿主病（haGVHD；发热、皮疹、腹泻和肝功能障碍）的发病率及临床表现，并分析了其危险因素以及haGVHD对异基因干细胞移植（SCT）结果的影响。共有90例患者接受了来自71名匹配同胞或19名替代供者的异基因SCT。对符合标准的22例患者立即给予大剂量类固醇治疗。haGVHD的总体发病率为36.7%（n = 34），且haGVHD还与急性移植物抗宿主病（aGVHD）（P < 0.001）和广泛慢性移植物抗宿主病（cGVHD）（P = 0.007）密切相关，同时发现其与复发概率降低相关（P = 0.0017）。在诊断haGVHD后7天内早期使用类固醇干预可能与更好的生存率相关。对总生存期和无病生存期的生存分析未显示haGVHD阳性组和阴性组之间存在任何差异。在多变量分析中，使用替代供者（P = 0.020）被确定为唯一的危险因素。立即给予大剂量类固醇治疗haGVHD有效。我们得出结论，在异基因移植环境中，haGVHD并非罕见表现，与aGVHD或cGVHD的发生相关。haGVHD的唯一危险因素是使用替代供者。
