Arora M, Nagaraj S, Witte J, DeFor T E, MacMillan M, Burns L J, Weisdorf D J
Blood and Marrow Transplant Program, Division of Hematology, Oncology and Transplantation, Department of Medicine, University of Minnesota, Minneapolis, MN 55455, USA.
Bone Marrow Transplant. 2009 Jan;43(2):149-53. doi: 10.1038/bmt.2008.305. Epub 2008 Sep 15.
The Diagnosis and Staging Working Group of the NIH Consensus Development Project on Criteria for Clinical Trials in chronic GVHD (CGVHD) recently proposed criteria for diagnosis and assessment of overall CGVHD severity. We retrospectively reviewed 54 consecutive patients diagnosed with CGVHD between January 2002 and December 2005 after sibling donor transplant to assess the applicability of the new criteria in prognosticating survival and transplant-related mortality (TRM). A total of 8 patients (15%) were reclassified as late onset/persistent or recurrent acute GVHD (late aGVHD), 15 (28%) had overlap syndrome and 31 (57%) had classic CGVHD. Three-year overall survival was worse in patients with late aGVHD (3-year probability 25% (95% CI 4-56%)) followed by overlap syndrome (3-year probability 87% (95% CI 56-96%)) and CGVHD (3-year probability 75% (95% CI 54-87%)); P=0.001. Among patients with overlap syndrome and CGVHD, a trend towards worse survival was seen in patients with severe disease (3-year probability 57.3% (95% CI 21-82%)) as compared to mild+moderate disease (3-year probability 85.1% (95% CI 68-94)); P=0.1. This analysis, undertaken in a contemporary cohort of related donor recipients, indicates that the consensus guidelines are applicable to this population of CGVHD patients.
美国国立卫生研究院（NIH）慢性移植物抗宿主病（CGVHD）临床试验标准共识发展项目的诊断与分期工作组最近提出了CGVHD总体严重程度的诊断和评估标准。我们回顾性分析了2002年1月至2005年12月间接受同胞供体移植后被诊断为CGVHD的54例连续患者，以评估新标准在预测生存和移植相关死亡率（TRM）方面的适用性。共有8例患者（15%）被重新分类为迟发性/持续性或复发性急性移植物抗宿主病（迟发性aGVHD），15例（28%）有重叠综合征，31例（57%）有典型的CGVHD。迟发性aGVHD患者的3年总生存率较差（3年概率为25%（95%CI 4-56%）），其次是重叠综合征患者（3年概率为87%（95%CI 56-96%））和CGVHD患者（3年概率为75%（95%CI 54-87%））；P=0.001。在重叠综合征和CGVHD患者中，与轻度+中度疾病患者（3年概率为85.1%（95%CI 68-94%））相比，重度疾病患者的生存率有下降趋势（3年概率为57.3%（95%CI 21-82%））；P=0.1。在当代相关供体受者队列中进行的这项分析表明，共识指南适用于这组CGVHD患者。
