Lin Qu, Dong Min, Wang Qing-Ming, Wen Jing-Yun, Wu Xiang-Yuan
Department of Oncology, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510630, P. R. China.
Ai Zheng. 2006 Oct;25(10):1261-5.
BACKGROUND & OBJECTIVE: Graft-versus-host disease (GVHD) is a major complication of allogeneic hematopoietic stem cell transplantation (allo-HSCT), and also is an important factor affecting the outcome of transplantation. Some researches showed that either acute or chronic GVHD is often accompanied by graft-versus-leukemia (GVL) effect, and this positive effect is associated with the decrease of leukemia relapse and the prolongation of disease-free survival of recipients. This study was to assess the influence of GVHD on the outcome of allo-HSCT.
Twenty-six patients with hematologic malignancies received allo-HSCT from Mar. 1995 to Oct. 2005. The occurrence of GVHD, relapse of leukemia, and survival of recipients were analyzed retrospectively, and the correlations of GVHD to leukemia relapse and patients' survival were evaluated.
With a median follow-up of 20 months (range 2-127 months) after transplantation, 20 (76.9%) patients developed GVHD, 1 of which had tumor relapsed; 3 of the 6 patients without GVHD had tumor relapsed. The relapse rate was significantly lower in the recipients with GVHD than in the recipients without GVHD (P<0.05). After transplantation, 16 patients survived disease-freely, and 10 died. Kaplan-Meier survival curves showed that the 3-year disease-freely survival rate was 60%. The disease-freely survival rate was significantly higher in the recipients with GVHD than in the recipients without GVHD (15/20 vs. 1/6, log-rank=7.30, P<0.05). Cox regression models showed a significantly decreased risk of death in the recipients with GVHD (risk ratio=0.2, P<0.05). Of the 20 recipients with GVHD, 17 achieved complete response (CR), 15 of whom survived disease-freely; no survived in the 3 patients who did not achieve CR. The disease-freely survival rate was significantly higher in the recipients achieved CR than in the recipients did not (P<0.05).
GVHD is an important factor that may influence the outcome of allo-HSCT. Treatment efficacy of GVHD is significantly associated with the disease-free survival of recipients. Early recognition and treatment of acute GVHD is the key factor of successful treatment.
移植物抗宿主病（GVHD）是异基因造血干细胞移植（allo-HSCT）的主要并发症，也是影响移植结局的重要因素。一些研究表明，急性或慢性GVHD常伴有移植物抗白血病（GVL）效应，这种积极效应与白血病复发率降低及受者无病生存期延长相关。本研究旨在评估GVHD对allo-HSCT结局的影响。
回顾性分析1995年3月至2005年10月期间接受allo-HSCT的26例血液系统恶性肿瘤患者。分析GVHD的发生情况、白血病复发情况及受者生存情况，并评估GVHD与白血病复发及患者生存的相关性。
移植后中位随访20个月（范围2 - 127个月），20例（76.9%）患者发生GVHD，其中1例肿瘤复发；6例未发生GVHD的患者中有3例肿瘤复发。发生GVHD的受者复发率显著低于未发生GVHD的受者（P<0.05）。移植后16例患者无病生存，10例死亡。Kaplan-Meier生存曲线显示3年无病生存率为60%。发生GVHD的受者无病生存率显著高于未发生GVHD的受者（分别为15/20和1/6，对数秩检验=7.30，P<0.05）。Cox回归模型显示发生GVHD的受者死亡风险显著降低（风险比=0.2，P<0.05）。20例发生GVHD的受者中，17例达到完全缓解（CR），其中15例无病生存；未达到CR的3例患者均无生存。达到CR的受者无病生存率显著高于未达到CR的受者（P<0.05）。
GVHD是可能影响allo-HSCT结局的重要因素。GVHD的治疗效果与受者的无病生存显著相关。早期识别和治疗急性GVHD是治疗成功的关键因素。
