Department of Hematology, University Hospital of Basel, Basel, Switzerland.
Haematologica. 2011 Jan;96(1):150-5. doi: 10.3324/haematol.2010.030874. Epub 2010 Sep 17.
Hematopoietic stem cell transplantation has become an established procedure worldwide. Severe early and late complications are well described. Little is known about more subtle changes in general health status of very long-term survivors. The study objective was to assess health status of very long-term survivors in comparison with their respective human leukocyte antigen-identical sibling donors.
Case matched comparison in a cross-sectional cohort was performed in a tertiary university hospital and referral center for hematopoietic stem cell transplantation. Forty-four pairs of recipients and their respective donors with a very long-term (17.5 years median; 11-26 years range) follow up after allogeneic hematopoietic stem cell transplantation were included. A comparative clinical evaluation and examination of routine clinical chemistry tests was carried out.
Recipients more frequently had a lower Karnofsky score (P = 0.05), hypertension (P = 0.015) and dyslipidemia (P = 0.002) but were less likely to be smokers (P = 0.016). Recipients showed systematically lower glomerular filtration rates (P < 0.0001), higher liver function tests (P = 0.0004 for Aspartat-Amino-Transferase) and reduced thyroid function (P = 0.002) despite normal or near normal values, and independent of presence or absence of chronic graft-versus-host disease. Indicators of inflammation were more frequent in recipients (9 of 44) with ongoing chronic graft-versus-host disease as measured by higher C-reactive protein (P = 0.001) and higher von Willebrand factor (P = 0.002). Conclusions Clinically very long-term survivors after an allogeneic hematopoietic stem cell transplantation present more frequently with cardiovascular risk factors and with subtle signs of altered organ function compared to their sibling donors. Even minimal ongoing chronic graft-versus-host disease remains associated with elevated laboratory indicators of inflammation. The clinical significance of these findings needs to be defined.
造血干细胞移植已在全球范围内成为一种既定的治疗手段。其严重的早期和晚期并发症已有详尽描述。然而，对于长期存活者的整体健康状况的更细微变化却知之甚少。本研究旨在评估与 HLA 相同的同胞供者相比，长期存活者的健康状况。
在一所三级大学医院和造血干细胞移植转诊中心进行了病例匹配的横断面队列研究。共纳入 44 对接受异基因造血干细胞移植后随访时间超过 17.5 年（范围为 11-26 年）的受者及其各自的供者。对他们进行了临床评估和常规临床化学检测。
与供者相比，受者的卡氏评分较低（P = 0.05）、高血压（P = 0.015）和血脂异常（P = 0.002）更为常见，但吸烟的可能性较低（P = 0.016）。尽管肾小球滤过率（P < 0.0001）、肝功能试验（P = 0.0004，天门冬氨酸氨基转移酶）和甲状腺功能（P = 0.002）的正常值或接近正常值，但受者的这些指标更低，且与慢性移植物抗宿主病的存在与否无关。有 9 例（9/44）持续存在慢性移植物抗宿主病的受者炎症标志物更为常见，表现为 C 反应蛋白（P = 0.001）和血管性血友病因子（P = 0.002）升高。
与同胞供者相比，异基因造血干细胞移植后长期存活者的心血管危险因素更为常见，且器官功能改变的细微迹象更为常见。即使存在轻微的慢性移植物抗宿主病，也与实验室炎症标志物的升高相关。这些发现的临床意义需要进一步明确。
