Division of Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, WA 98109-1024, USA.
Blood. 2011 Jul 14;118(2):456-63. doi: 10.1182/blood-2011-01-330217. Epub 2011 Jun 1.
This study was conducted to elucidate the influence of immunosuppressive treatment (IST) and GVHD on risk of recurrent malignancy after allogeneic hematopoietic cell transplantation (HCT). The study cohort included 2656 patients who received allogeneic HCT after high-intensity conditioning regimens for treatment of hematologic malignancies. Rates and hazard ratios of relapse and mortality were analyzed according to GVHD and IST as time-varying covariates. Adjusted Cox analyses showed that acute and chronic GVHD were both associated with statistically similar reductions in risk of relapse beyond 18 months after HCT but not during the first 18 months. In patients with GVHD, resolution of GVHD followed by withdrawal of IST was not associated with a subsequent increase in risk of relapse. In patients without GVHD, withdrawal of IST was associated with a reduced risk of relapse during the first 18 months, but the risk of subsequent relapse remained considerably higher than in patients with GVHD. In summary, the association of GVHD with risk of relapse changes over time after HCT. In patients without GVHD, early withdrawal of IST might help to prevent relapse during the first 18 months, but other interventions would be needed to prevent relapse at later time points.
本研究旨在阐明免疫抑制治疗（IST）和移植物抗宿主病（GVHD）对异基因造血细胞移植（HCT）后复发性恶性肿瘤风险的影响。该研究队列包括 2656 名接受高强度预处理方案治疗血液系统恶性肿瘤的异基因 HCT 患者。根据 GVHD 和 IST 作为时变协变量，分析复发和死亡率的发生率和危险比。调整后的 Cox 分析显示，急性和慢性 GVHD 均与 HCT 后 18 个月后复发风险的统计学显著降低相关，但在 18 个月内无相关性。在有 GVHD 的患者中，GVHD 缓解后 IST 的停药与随后复发风险的增加无关。在没有 GVHD 的患者中，IST 的停药与前 18 个月复发风险降低相关，但随后复发的风险仍明显高于有 GVHD 的患者。总之，GVHD 与 HCT 后复发风险的关联随时间而变化。在没有 GVHD 的患者中，早期停止 IST 可能有助于预防前 18 个月的复发，但需要其他干预措施来预防后期的复发。
