Lee Stephanie J, Flowers Mary E D
Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA.
Hematology Am Soc Hematol Educ Program. 2008:134-41. doi: 10.1182/asheducation-2008.1.134.
Chronic graft-versus-host disease (GVHD) is an immune-mediated disorder that occurs frequently after allogeneic hematopoietic cell transplantation (HCT). Most cases are diagnosed within the first year at a median of 4 to 6 months after HCT, but 5-10% of cases are initially diagnosed beyond the first post-transplant year. Chronic GVHD most often involves the skin and mouth, but almost any other organ system can be involved. Correct diagnosis is critical so that appropriate therapy can be started promptly to minimize symptoms and prevent irreversible organ damage. Initial treatment should be with cortico-steroid-based therapy. Optimal secondary treatment as not been established, although a large number of agents may provide benefits. A 2004 NIH conference focused on development of consensus criteria for chronic GVHD. Six papers published in 2005 and 2006 propose consensus definitions for chronic GVHD diagnosis and scoring, pathology, biomarkers, response criteria, supportive care and design of clinical trials. This review will focus on common clinical presentations and principles for managing chronic GVHD. The most frequently used secondary therapies and ongoing trials are summarized. New concepts from the NIH consensus conference are discussed.
慢性移植物抗宿主病（GVHD）是一种免疫介导的疾病，常在异基因造血细胞移植（HCT）后频繁发生。大多数病例在HCT后4至6个月的第一年被诊断出来，但5%-10%的病例最初在移植后的第一年之后被诊断出来。慢性GVHD最常累及皮肤和口腔，但几乎任何其他器官系统都可能受累。正确诊断至关重要，以便能迅速开始适当治疗，将症状降至最低并防止不可逆转的器官损害。初始治疗应以皮质类固醇为基础。尽管大量药物可能有益，但尚未确定最佳的二线治疗方法。2004年美国国立卫生研究院（NIH）会议聚焦于慢性GVHD共识标准的制定。2005年和2006年发表的六篇论文提出了慢性GVHD诊断和评分、病理学、生物标志物、反应标准、支持治疗及临床试验设计的共识定义。本综述将聚焦于慢性GVHD的常见临床表现及管理原则。总结了最常用的二线治疗方法及正在进行的试验。讨论了NIH共识会议提出的新概念。
