Graft-versus-Host and Autoimmunity Unit, Experimental Transplantation and Immunology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA.
Leukemia. 2012 Apr;26(4):633-43. doi: 10.1038/leu.2011.254. Epub 2011 Oct 18.
Chronic graft-versus-host disease (cGVHD) remains a major cause of non-relapse morbidity and mortality after allogeneic hematopoietic stem cell transplantation. Currently there are no accepted measures of cGVHD activity to aid in clinical management and disease staging. We analyzed clinical markers of inflammation in the sera of patients with established cGVHD and correlated those with definitions of disease activity. In all, 189 adults with cGVHD (33% moderate and 66% severe according to National Institutes of Health (NIH) global scoring) were consecutively enrolled onto a cross-sectional prospective cGVHD natural history study. At the time of evaluation, 80% were receiving systemic immunosuppression and failed a median of four prior systemic therapies (PST) for their cGVHD. Lower albumin (P<0.0001), higher C-reactive protein (P = 0.043), higher platelets (P = 0.030) and higher number of PST (P<0.0001) were associated with active disease defined as clinician's intention to intensify or alter systemic therapy due to the lack of response. Higher platelet count (P = 0.021) and higher number of PST (P<0.0001) were associated with more severe diseased defined by NIH global score. This study identified common laboratory indicators of inflammation that can serve as markers of cGVHD activity and severity.
慢性移植物抗宿主病（cGVHD）仍然是异基因造血干细胞移植后非复发发病率和死亡率的主要原因。目前尚无公认的 cGVHD 活动指标来帮助临床管理和疾病分期。我们分析了已确诊的 cGVHD 患者血清中的炎症标志物，并将其与疾病活动的定义相关联。共有 189 名患有 cGVHD 的成年人（根据美国国立卫生研究院（NIH）全球评分，33%为中度，66%为重度）连续入组进行 cGVHD 自然史的横断面前瞻性研究。在评估时，80%的患者正在接受系统性免疫抑制治疗，并在其 cGVHD 中接受了中位数为 4 次的先前系统性治疗（PST）失败。较低的白蛋白（P<0.0001）、较高的 C 反应蛋白（P=0.043）、较高的血小板（P=0.030）和较多的 PST（P<0.0001）与活动性疾病相关，即由于缺乏反应而打算强化或改变系统性治疗的临床医生的意图。较高的血小板计数（P=0.021）和较多的 PST（P<0.0001）与 NIH 全球评分定义的更严重疾病相关。这项研究确定了常见的炎症实验室指标，可作为 cGVHD 活动和严重程度的标志物。
