与迟发性发病相比，早发性急性移植物抗宿主病（GVHD）表明慢性 GVHD 的严重程度更差，结局更差。

Early onset of acute GVHD indicates worse outcome in terms of severity of chronic GVHD compared with late onset.

机构信息

Department of Hematology/Oncology, Kyungpook National University Hospital, Daegu, Korea.

出版信息

Bone Marrow Transplant. 2010 Oct;45(10):1540-5. doi: 10.1038/bmt.2010.12. Epub 2010 Mar 1.

DOI:10.1038/bmt.2010.12

PMID:20190848

Abstract

Acute GVHD (aGVHD) is an important risk factor for predicting the incidence or severity of chronic GVHD (cGVHD). Transplant outcome can be influenced by the onset time of aGVHD in patients who have received allogeneic PBSC transplants (PBSCTs). The medical records of 134 patients who survived more than 3 months after myeloablative allogeneic PBSCT were retrospectively reviewed. In all, 38 patients (28.4%) developed grade II-IV aGVHD before day +28 (early aGVHD) and 25 patients (18.7%) after day +28 (late aGVHD). The 5-year cumulative incidence of cGVHD was 78.9% in the early-aGVHD group and 56.6% in the late-aGVHD group (P=0.034). The 5-year OS was 51.0% for the early-aGVHD and 80.8% for the late-aGVHD group (P=0.406). Infection was the primary cause of death for the early-aGVHD group (51.4 vs 16.7%, P=0.017), whereas relapse of the primary disease was higher among the patients with late aGVHD, although this was statistically insignificant (58.3 vs 25.7%, P=0.309). In a multivariate analysis, early aGVHD was identified as a risk factor for developing cGVHD (hazard ratio (HR) 2.278, P=0.004). The development of aGVHD early after allogeneic PBSCT increased the risk of cGVHD and infection-related death rate when compared with the late onset of aGVHD.

摘要

移植物抗宿主病（GVHD）是预测慢性移植物抗宿主病（cGVHD）发生率或严重程度的重要危险因素。异基因 PBSC 移植（PBSCT）患者的 GVHD 发病时间会影响移植结果。回顾性分析了 134 例接受清髓性异基因 PBSCT 后存活时间超过 3 个月的患者的病历。共有 38 例（28.4%）患者在+28 天前（早发性 GVHD）和 25 例（18.7%）患者在+28 天后（迟发性 GVHD）发生 II-IV 级 GVHD。早发性 GVHD 组和迟发性 GVHD 组的 5 年累积 cGVHD 发生率分别为 78.9%和 56.6%（P=0.034）。早发性 GVHD 组的 5 年 OS 为 51.0%，迟发性 GVHD 组为 80.8%（P=0.406）。感染是早发性 GVHD 组死亡的主要原因（51.4%比 16.7%，P=0.017），而迟发性 GVHD 组患者的原发疾病复发率较高，但差异无统计学意义（58.3%比 25.7%，P=0.309）。多因素分析显示，早发性 GVHD 是发生 cGVHD 的危险因素（风险比（HR）2.278，P=0.004）。与迟发性 GVHD 相比，异基因 PBSCT 后早期发生 GVHD 会增加 cGVHD 和感染相关死亡率的风险。