Johnston Laura
Division of Blood and Marrow Transplantation, Stanford University, 300 Pasteur Drive, H3249, Stanford, CA 94305, USA.
Best Pract Res Clin Haematol. 2008 Jun;21(2):177-92. doi: 10.1016/j.beha.2008.02.006.
Acute graft-versus-host disease (aGVHD) is a constant component of allogeneic hematopoietic cell transplantation (HCT), with variations in incidence and severity affected by the graft source, human leukocyte antigen (HLA) compatibility, and the preparative regimen. The graft source - related versus unrelated donors, bone marrow (BM) versus peripheral blood (PB), umbilical cord blood (UCB) versus unrelated donor BM - are discussed in this review, as well as myeloablative versus reduced-intensity (RI) preparative regimens. Recent comparisons of matched related versus matched unrelated donor HCT support a minimal difference in aGVHD between these two donor sources. The use of BM versus mobilized PB in the matched related donor (MRD) setting has been compared in randomized as well as phase-II comparative clinical trials which support a slight increase in aGVHD in the adult population. Similar results have been seen in the unrelated donor (URD) setting, although based on minimal comparative data to date. Preliminary comparisons of UCB versus URD BM have shown a decreased incidence of aGVHD with UCB, despite increased HLA mismatching. Haploidentical HCT has continued to be explored, with limitations due to delayed immune reconstitution and disease relapse. Many reduced-intensity preparative regimens have been published, with a reduced or minimal difference in incidence of aGVHD when historically compared to myleoablative preparative regimens. More formal comparisons of the different graft sources as well as preparative regimen intensities will be required to determine a more accurate picture of the differences between these transplantation alternatives.
急性移植物抗宿主病（aGVHD）是异基因造血细胞移植（HCT）的常见并发症，其发病率和严重程度受移植物来源、人类白细胞抗原（HLA）相容性及预处理方案的影响。本综述将讨论移植物来源，即相关与非相关供者、骨髓（BM）与外周血（PB）、脐带血（UCB）与非相关供者骨髓，以及清髓性与减低强度（RI）预处理方案。近期对匹配的相关供者与匹配的非相关供者HCT的比较显示，这两种供者来源的aGVHD差异极小。在匹配的相关供者（MRD）情况下，对BM与动员的PB的使用进行了随机及II期比较临床试验，结果支持成年人群中aGVHD略有增加。在非相关供者（URD）情况下也观察到了类似结果，尽管目前基于的比较数据极少。UCB与URD BM的初步比较显示，尽管HLA错配增加，但UCB的aGVHD发病率降低。单倍体相合HCT仍在不断探索中，存在免疫重建延迟和疾病复发的局限性。已发表了许多减低强度预处理方案，与清髓性预处理方案相比，其aGVHD发病率降低或差异极小。需要对不同移植物来源以及预处理方案强度进行更正式的比较，以更准确地了解这些移植选择之间的差异。
