Jagasia Madan, Giglia Jennifer, Chinratanalab Wichai, Dixon Sheri, Chen Heidi, Frangoul Haydar, Engelhardt Brian, Goodman Stacey, Greer John, Kassim Adetola, Morgan David, Ruffner Katherine, Schuening Friedrich
Division of Hematology-Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee 37232, USA.
Biol Blood Marrow Transplant. 2007 Oct;13(10):1207-15. doi: 10.1016/j.bbmt.2007.07.001. Epub 2007 Aug 24.
Chronic graft-versus-host disease (cGVHD), a common complication after stem cell transplant (SCT), has an impact on morbidity and survival. Previous classification of cGVHD has not been reproducible or prognostic for nonrelapse mortality (NRM). Recently the National Institutes of Health (NIH) consensus criteria were proposed, but the ability of this classification to predict outcome of various subtypes of cGVHD is unknown. Patients (N = 110) undergoing an SCT for a hematologic malignancy and surviving until day 100 posttransplant from 2001 to 2003 were studied. The overall survival (OS) using a landmark analysis at day 100 was 44% versus 66% (no GVHD vs. GVHD, P = .026). The OS of patients with various types of GVHD as proposed by the NIH criteria were significantly different (P < .0001). In a univariate analyses, this was more apparent when patients with any acute features of GVHD were compared to classic cGVHD (3-year OS 46% vs. 68%, P = .033). The 3-year NRM for the entire cohort was 21%, and was not affected by presence or absence of GVHD or subtypes of GVHD. In a multivariable analysis, extensive cGVHD (hazard ratio [HR] 0.35, P = .015) and having any acute feature of GVHD after day 100 (HR 3.36, P = .0144) were significant independent predictors of survival. The OS with different NIH subtypes of GVHD after day 100 from SCT varies, and is superior for patients with classic cGVHD.
慢性移植物抗宿主病（cGVHD）是干细胞移植（SCT）后的常见并发症，会影响发病率和生存率。先前对cGVHD的分类对于非复发死亡率（NRM）而言既不可重复，也无预后价值。最近提出了美国国立卫生研究院（NIH）的共识标准，但该分类预测cGVHD各种亚型预后的能力尚不清楚。对2001年至2003年因血液系统恶性肿瘤接受SCT且移植后存活至第100天的110例患者进行了研究。采用第100天的标志性分析，总生存率（OS）在无移植物抗宿主病（GVHD）组与有GVHD组分别为44%和66%（P = 0.026）。根据NIH标准，不同类型GVHD患者的OS有显著差异（P < 0.0001）。在单变量分析中，将有任何急性GVHD特征的患者与典型cGVHD患者相比时，这种差异更为明显（3年OS分别为46%和68%，P = 0.033）。整个队列的3年NRM为21%，不受GVHD的有无或GVHD亚型的影响。在多变量分析中，广泛型cGVHD（风险比[HR] 0.35，P = 0.015）和移植后第100天之后出现任何急性GVHD特征（HR 3.36，P = 0.0144）是生存的显著独立预测因素。SCT后第100天不同NIH亚型GVHD患者的OS各不相同，典型cGVHD患者的OS更佳。
