Ringdén O, Klaesson S, Sundberg B, Ljungman P, Lönnqvist B, Persson U
Department of Clinical Immunology, Karolinska Institute, Huddinge Hospital, Stockholm, Sweden.
Bone Marrow Transplant. 1992 Jan;9(1):19-25.
Recipients receiving marrow from donors other than HLA identical siblings (alternative donors) treated by monotherapy with either methotrexate (MTX, n = 5) or cyclosporin A (CSA, n = 10) were compared with 28 recipients of alternative donor marrow receiving MTX + CSA. The former group had a cumulative incidence of grade II-IV acute graft-versus-host disease (GVHD) of 73% compared with 34% in the latter group (p = 0.009). The incidence of chronic GVHD was 75% and 41% in the two groups respectively, a difference that was not statistically significant. Death caused by GVHD was 47% in recipients of alternative bone marrow treated with monotherapy vs 12% in those treated with MTX + CSA (p = 0.008). The actuarial 4-year patient survival was 7% and 46% in the two groups, respectively (p = 0.04). Compared with HLA identical siblings the recipients of alternative marrow treated with monotherapy had an increased risk of grade II-IV acute GVHD (p less than 0.0001), an increased death rate by GVHD (p = 0.0001) and a decreased survival (p less than 0.0001). When MTX was combined with CSA the recipients of alternative marrow had an increased risk of grade II-IV acute GVHD (p = 0.005), but death by GVHD (12 vs 6%) and 4-year patient survival (46 vs 45%) did not differ.
将接受甲氨蝶呤（MTX，n = 5）或环孢素A（CSA，n = 10）单药治疗的非HLA相同同胞供者（替代供者）骨髓的受者与28例接受MTX + CSA治疗的替代供者骨髓受者进行比较。前一组II-IV级急性移植物抗宿主病（GVHD）的累积发生率为73%，而后一组为34%（p = 0.009）。两组慢性GVHD的发生率分别为75%和41%，差异无统计学意义。单药治疗的替代骨髓受者中因GVHD导致的死亡率为47%，而接受MTX + CSA治疗的受者中这一比例为12%（p = 0.008）。两组的4年精算患者生存率分别为7%和46%（p = 0.04）。与HLA相同同胞相比，接受单药治疗的替代骨髓受者发生II-IV级急性GVHD的风险增加（p < 0.0001），因GVHD导致的死亡率增加（p = 0.0001），生存率降低（p < 0.0001）。当MTX与CSA联合使用时，替代骨髓受者发生II-IV级急性GVHD的风险增加（p = 0.005），但因GVHD导致的死亡率（12%对6%）和4年患者生存率（46%对45%）没有差异。
