Teuffel O, Schrauder A, Sykora K W, Zimmermann M, Reiter A, Welte K, Schrappe M
Department of Pediatric Hematology and Oncology, Children's Hospital, Hannover Medical School (MHH), Hannover, Germany.
Bone Marrow Transplant. 2005 Jul;36(2):145-50. doi: 10.1038/sj.bmt.1705010.
Experimental and clinical data demonstrate an antileukemia effect of acute graft-versus-host disease (aGVHD). In all, 58 pediatric patients with acute lymphoblastic leukemia (ALL) who had received an allogeneic bone marrow transplant (BMT) at our institution were retrospectively analyzed for a correlation between the development of aGVHD and leukemic relapse. Probability of relapse after 5 (3) years was 13% (7%) in patients developing grade II-IV aGVHD vs 30% in patients with grade 0 or I aGVHD. There was a trend for a difference of the point estimates at 3 years, but no overall significance because of an unusual late relapse. Moreover, we analyzed the impact of cyclosporin A (CsA) on aGVHD in a subgroup of 22 children who had received a matched sibling donor (MSD) BMT. An increased dose of CsA within the first 2 weeks after BMT led to decreased occurrence and severity of aGVHD (P=0.035). The cumulative CsA dose appeared to have more impact than the average CsA whole-blood levels within the first 2 weeks and than the CsA dose given from day 15 to 40. In this subgroup, no life-threatening aGVHD or death from aGVHD occurred. In all cases (6/22), leukemic relapse was the cause of death. We therefore suggest that there is a relation between dose of CsA and relapse rate in childhood ALL transplanted from a MSD.
实验和临床数据表明急性移植物抗宿主病（aGVHD）具有抗白血病作用。我们对在本机构接受异基因骨髓移植（BMT）的58例急性淋巴细胞白血病（ALL）患儿进行了回顾性分析，以探讨aGVHD的发生与白血病复发之间的相关性。发生II-IV级aGVHD的患者5（3）年后的复发概率为13%（7%），而0级或I级aGVHD患者的复发概率为30%。3年时的点估计值存在差异趋势，但由于出现异常的晚期复发，总体无显著性差异。此外，我们在22例接受匹配同胞供体（MSD）BMT的儿童亚组中分析了环孢素A（CsA）对aGVHD的影响。BMT后前2周内增加CsA剂量可导致aGVHD的发生率和严重程度降低（P=0.035）。在前2周内，CsA的累积剂量似乎比平均全血CsA水平以及第15至40天给予的CsA剂量影响更大。在该亚组中，未发生危及生命的aGVHD或因aGVHD导致的死亡。在所有病例（6/22）中，白血病复发是死亡原因。因此，我们认为从MSD接受移植的儿童ALL中，CsA剂量与复发率之间存在关联。
