Department of Pediatrics, The Center for Cancer and Blood Disorders, The Children's Hospital and University of Colorado Denver School of Medicine, Aurora, CO 80045, USA.
Bone Marrow Transplant. 2011 May;46(5):668-75. doi: 10.1038/bmt.2010.174. Epub 2010 Aug 2.
We reviewed our experience in 79 children who had unrelated cord blood transplant (UCBT) between 1996 and 2007 with a major focus on GVHD, comparing both traditional and National Institute of Health (NIH) criteria. The cumulative incidence (CI) of acute GVHD (aGVHD, by day +100) was 0.42 for grade II-IV and 0.22 for grade III-IV. The CI of all aGVHD (NIH, that is, no time limit) at 1 year was 0.45 for grade II-IV and 0.32 for grade III-IV. Infused CD34 cell dose (>1 × 10(5)/kg), pretransplant bacterial infection and nonmalignant disorders were risk factors for grade II-IV aGVHD on univariate analysis. Infused CD34 cell dose remained significant on multivariate analysis. At 1 year, the CI of chronic GVHD (cGVHD) using the Seattle criteria was 0.27, whereas that for cGVHD (NIH) was 0.08. By NIH criteria, the classic form of cGVHD was uncommon (5%) after UCBT. Instead, the acute (71%) and overlap (24%) GVHD variants predominated. Grade II-IV aGVHD was a significant risk factor for cGVHD by both Seattle and NIH criteria. We conclude that GVHD after day +100 after UCBT typically carries features of aGVHD. Moreover, and in marked contrast to adult unrelated donor hematopoietic stem cell transplantation, the GVHD observed in this series did not adversely affect survival.
我们回顾了 1996 年至 2007 年间 79 例无关脐带血移植（UCBT）患儿的经验，主要关注移植物抗宿主病（GVHD），比较了传统和美国国立卫生研究院（NIH）标准。急性移植物抗宿主病（aGVHD，至+100 天）的累积发生率（CI）为 0.42 级至 4 级和 0.22 级至 3 级 4 级。1 年时所有 aGVHD（NIH，即无时间限制）的 CI 为 0.45 级至 4 级和 0.32 级至 3 级 4 级。输注 CD34 细胞剂量（>1×10(5)/kg）、移植前细菌感染和非恶性疾病是单变量分析中 2-4 级 aGVHD 的危险因素。输注 CD34 细胞剂量在多变量分析中仍然有意义。1 年时，西雅图标准的慢性移植物抗宿主病（cGVHD）CI 为 0.27，而 NIH 标准的 cGVHD 为 0.08。根据 NIH 标准，UCBT 后经典型 cGVHD 并不常见（5%）。相反，急性（71%）和重叠（24%）GVHD 变异型占主导地位。西雅图和 NIH 标准均认为 2-4 级 aGVHD 是 cGVHD 的显著危险因素。我们得出结论，UCBT 后+100 天的 GVHD 通常具有 aGVHD 的特征。此外，与成人无关供体造血干细胞移植相比，该系列观察到的 GVHD 并未对生存产生不利影响。
