Vanderbilt University Medical Center, Nashville, TN 37232-5505, USA.
Blood. 2012 Jan 5;119(1):296-307. doi: 10.1182/blood-2011-06-364265. Epub 2011 Oct 18.
Risk factors for acute GVHD (AGVHD), overall survival, and transplant-related mortality were evaluated in adults receiving allogeneic hematopoietic cell transplants (1999-2005) from HLA-identical sibling donors (SDs; n = 3191) or unrelated donors (URDs; n = 2370) and reported to the Center for International Blood and Marrow Transplant Research, Minneapolis, MN. To understand the impact of transplant regimen on AGVHD risk, 6 treatment categories were evaluated: (1) myeloablative conditioning (MA) with total body irradiation (TBI) + PBSCs, (2) MA + TBI + BM, (3) MA + nonTBI + PBSCs, (4) MA + nonTBI + BM, (5) reduced intensity conditioning (RIC) + PBSCs, and (6) RIC + BM. The cumulative incidences of grades B-D AGVHD were 39% (95% confidence interval [CI], 37%-41%) in the SD cohort and 59% (95% CI, 57%-61%) in the URD cohort. Patients receiving SD transplants with MA + nonTBI + BM and RIC + PBSCs had significantly lower risks of grades B-D AGVHD than patients in other treatment categories. Those receiving URD transplants with MA + TBI + BM, MA + nonTBI + BM, RIC + BM, or RIC + PBSCs had lower risks of grades B-D AGVHD than those in other treatment categories. The 5-year probabilities of survival were 46% (95% CI, 44%-49%) with SD transplants and 33% (95% CI, 31%-35%) with URD transplants. Conditioning intensity, TBI and graft source have a combined effect on risk of AGVHD that must be considered in deciding on a treatment strategy for individual patients.
在接受来自 HLA 相同的同胞供体（SD；n=3191）或无关供体（URD；n=2370）的异基因造血细胞移植（1999-2005 年）的成年人中，评估了急性移植物抗宿主病（AGVHD）、总生存和移植相关死亡率的风险因素，并向明尼苏达州明尼阿波利斯市的国际血液和骨髓移植研究中心报告。为了了解移植方案对 AGVHD 风险的影响，评估了 6 种治疗类别：（1）全身照射（TBI）+PBSC 的清髓性调理（MA），（2）MA+TBI+BM，（3）MA+非 TBI+PBSC，（4）MA+非 TBI+BM，（5）强度降低调理（RIC）+PBSC，以及（6）RIC+BM。SD 队列中 B-D 级 AGVHD 的累积发生率为 39%（95%置信区间[CI]，37%-41%），URD 队列中为 59%（95% CI，57%-61%）。接受 SD 移植的 MA+非 TBI+BM 和 RIC+PBSC 的患者发生 B-D 级 AGVHD 的风险明显低于其他治疗类别的患者。接受 URD 移植的 MA+TBI+BM、MA+非 TBI+BM、RIC+BM 或 RIC+PBSC 的患者发生 B-D 级 AGVHD 的风险低于其他治疗类别的患者。SD 移植的 5 年生存率为 46%（95% CI，44%-49%），URD 移植的为 33%（95% CI，31%-35%）。调理强度、TBI 和移植物来源对 AGVHD 的风险有综合影响，在为个体患者制定治疗策略时必须考虑到这一点。
