Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
Biol Blood Marrow Transplant. 2013 Jul;19(7):1129-33. doi: 10.1016/j.bbmt.2013.04.018. Epub 2013 Apr 25.
The optimal therapy for steroid-refractory (SR) acute graft-versus-host disease (aGVHD) is undefined. We studied patients with SR aGVHD, comparing extracorporeal photopheresis (ECP; n = 57) and anticytokine therapy (n = 41). In multivariate analyses, ECP, adjusted for steroid dose (odds ratio, 3.42; P = .007), and grade >II aGVHD (odds ratio, 68; P < .001) were independent predictors of response. ECP therapy, adjusted for conditioning regimen intensity and steroid dose, was associated with superior survival (hazard ratio [HR], 4.6; P = .016) in patients with SR grade II aGVHD. Grade >II aGVHD at onset of salvage therapy (HR, 9.4; P < .001) and lack of response to therapy (HR, 3.09; P = .011) were associated with inferior survival. These findings require validation in a prospective randomized study.
对于激素抵抗（SR）急性移植物抗宿主病（aGVHD），最佳的治疗方法尚未确定。我们研究了患有 SR aGVHD 的患者，比较了体外光分离（ECP；n = 57）和抗细胞因子治疗（n = 41）。多变量分析表明，ECP 与激素剂量调整（优势比，3.42；P =.007）和 II 级以上 aGVHD（优势比，68；P <.001）是反应的独立预测因素。对于接受 ECP 治疗的患者，调整了预处理方案强度和激素剂量，与 SR 级 II 度 aGVHD 患者的生存改善相关（风险比 [HR]，4.6；P =.016）。挽救性治疗开始时发生 II 级以上 aGVHD（HR，9.4；P <.001）和对治疗无反应（HR，3.09；P =.011）与生存不良相关。这些发现需要前瞻性随机研究进行验证。
