Sohn S K, Kim D H, Baek J H, Kim J G, Lee K B, Lee K-H, Lee J-H, Choi S-J, Lee J-H, Shin I-H
Department of Hematology/Oncology, Kyungpook National University Hospital, Daegu, Korea.
Bone Marrow Transplant. 2006 Apr;37(7):699-708. doi: 10.1038/sj.bmt.1705313.
This study attempts to identify variables that can predict the development of progressive- or quiescent-type chronic GVHD (pq cGVHD) and transplant outcomes after the diagnosis of cGVHD in 99 patients who experienced acute GVHD (aGVHD) after allogeneic SCT. The prognostic significance of various clinical parameters at diagnosis of cGVHD was examined to determine the prognostic factors for GVHD-specific survival (GSS) in patients with pq cGVHD. Among 118 patients who experienced any degree of aGVHD, 99 were evaluated for cGVHD. The incidence of overall and extensive pq cGVHD at 2 years was estimated as 84.4 and 63.1%, respectively. A multivariate analysis showed that severe aGVHD (grade 3, 4) (P=0.022), primary treatment failure (P=0.009) and elevated alkaline phosphatase (P=0.001) were all significant independent factors predicting a higher overall incidence of pq cGVHD. The GSS and probability of systemic immunosuppressive treatment at 2 years after diagnosis of cGVHD were estimated as 55.9 and 51.9%. GVHD-specific survival was significantly associated with performance status (P=0.004) and lymphocytopenia (<or=1000/microl, P=0.022) at diagnosis of cGVHD by Cox's proportional hazard model. Severe aGVHD, primary treatment failure (PTF), lymphocytopenia and elevated alkaline phosphatase may be useful predictive factors for the development of pq cGVHD in patients who experience aGVHD after allogeneic SCT.
本研究旨在确定在99例接受异基因造血干细胞移植（SCT）后发生急性移植物抗宿主病（aGVHD）的患者中，能够预测进展型或静止型慢性移植物抗宿主病（pq cGVHD）发生及cGVHD诊断后移植结局的变量。研究检查了cGVHD诊断时各种临床参数的预后意义，以确定pq cGVHD患者移植物抗宿主病特异性生存（GSS）的预后因素。在118例发生任何程度aGVHD的患者中，99例接受了cGVHD评估。2年时总体和广泛pq cGVHD的发生率分别估计为84.4%和63.1%。多变量分析显示，重度aGVHD（3级、4级）（P=0.022）、初始治疗失败（P=0.009）和碱性磷酸酶升高（P=0.001）均为预测pq cGVHD总体发生率较高的显著独立因素。cGVHD诊断后2年的GSS及全身免疫抑制治疗概率分别估计为55.9%和51.9%。根据Cox比例风险模型，cGVHD诊断时的体能状态（P=0.004）和淋巴细胞减少（≤1000/μl，P=0.022）与GSS显著相关。重度aGVHD、初始治疗失败（PTF）、淋巴细胞减少和碱性磷酸酶升高可能是异基因SCT后发生aGVHD患者pq cGVHD发生的有用预测因素。
