Division of Hematology, Saitama Medical Center, Jichi Medical University, Saitama, Japan.
Department of Hematopoietic Stem Cell Transplantation Data Management/Biostatistics, Nagoya University School of Medicine, Nagoya, Japan.
Bone Marrow Transplant. 2014 Feb;49(2):228-35. doi: 10.1038/bmt.2013.151. Epub 2013 Sep 30.
Few studies have evaluated the risk factors for chronic GVHD and organ involvement associated with different graft types, including unrelated cord blood (U-CB). We retrospectively studied 4818 adult patients who received their first allogeneic transplantation and survived for at least 100 days. The incidence of chronic GVHD at 2 years was 37%. The following factors were associated with the development of chronic GVHD: female donor/male recipient, CMV-Ab seropositivity, matched related peripheral blood grafts vs matched related BM grafts, no in vivo T-cell depletion and the occurrence of grade II-IV acute GVHD. Among these factors, the association with acute GVHD occurrence was consistently significant across donor subtypes. The use of U-CB was not associated with chronic GVHD, but was associated with a low incidence of extensive chronic GVHD. Chronic GVHD patients who had received U-CB transplants showed less frequent involvement of the oral cavity (28% vs 55%), eye (12% vs 26%), liver (20% vs 44%), lung (11% vs 25%) and joint (0% vs 6%) than those with matched related BM grafts. In conclusion, we found that U-CB transplants were associated with a low incidence of extensive chronic GVHD and less frequent involvement of the oral cavity, eye, liver, lung and joints.
很少有研究评估与不同移植物类型相关的慢性移植物抗宿主病和器官受累的风险因素，包括无关脐带血（U-CB）。我们回顾性研究了 4818 名接受首次异基因移植并至少存活 100 天的成年患者。2 年时慢性 GVHD 的发生率为 37%。以下因素与慢性 GVHD 的发生有关：女性供者/男性受者、CMV-Ab 阳性、匹配相关外周血移植物与匹配相关骨髓移植物、无体内 T 细胞耗竭和发生 II-IV 级急性 GVHD。在这些因素中，与急性 GVHD 发生的关联在供者亚型之间始终具有显著意义。使用 U-CB 与慢性 GVHD 无关，但与广泛慢性 GVHD 的发生率较低有关。接受 U-CB 移植的慢性 GVHD 患者口腔（28%比 55%）、眼睛（12%比 26%）、肝脏（20%比 44%）、肺部（11%比 25%）和关节（0%比 6%）受累的频率低于接受匹配相关骨髓移植物的患者。总之，我们发现 U-CB 移植与广泛慢性 GVHD 的发生率较低以及口腔、眼睛、肝脏、肺部和关节受累频率较低有关。
