Boström L, Ringdén O, Jacobsen N, Zwaan F, Nilsson B
Leukaemia Working Party of the European Group for Bone Marrow Transplantation.
Transplantation. 1990 Jun;49(6):1100-5. doi: 10.1097/00007890-199006000-00014.
A group of 466 leukemic bone marrow transplanted patients were reported from 17 European bone marrow transplantation teams. Of these, 285 survived more than 3 months and could be evaluated for chronic GVHD. The cumulative incidence of chronic GVHD was 32% two years after BMT. The following factors were statistically significantly associated with chronic GVHD in bivariate analysis: high donor and recipient age, splenecacute GVHD, pretransplant seropositivity to CMV among the recipients and the donors, and donor seropositivity to 3 or 4 different herpesviruses, compared with 0-2, prior to BMT. In multivariate analysis pretransplant recipient CMV seropositivity in combination with donor CMV seropositivity prior to BMT (P = 0.0006), a previous grade II-IV acute GVHD (P = 0.001), and splenectomy (P = 0.01) were significantly associated with chronic GVHD. Thus, in addition to acute GVHD, CMV immune donor cells may be triggered by latent CMV in the recipient, which may play a role in the triggering of chronic GVHD. The possible role of splenectomy in GVHD is also discussed.
17个欧洲骨髓移植团队报告了一组466例接受白血病骨髓移植的患者。其中，285例存活超过3个月，可对慢性移植物抗宿主病（GVHD）进行评估。骨髓移植后两年慢性GVHD的累积发病率为32%。在双变量分析中，以下因素与慢性GVHD在统计学上显著相关：供体和受体年龄较大、脾切除、急性GVHD、移植前受体和供体对巨细胞病毒（CMV）血清学阳性，以及与骨髓移植前对0 - 2种不同疱疹病毒血清学阳性相比，供体对3或4种不同疱疹病毒血清学阳性。在多变量分析中，移植前受体CMV血清学阳性与移植前供体CMV血清学阳性相结合（P = 0.0006）、既往II - IV级急性GVHD（P = 0.001）和脾切除术（P = 0.01）与慢性GVHD显著相关。因此，除了急性GVHD外，受体中潜伏的CMV可能触发CMV免疫的供体细胞，这可能在慢性GVHD的触发中起作用。还讨论了脾切除术在GVHD中的可能作用。
