Clinical Research Division, Fred Hutchinson Cancer Research Center and Department of Medicine, University of Washington, Seattle, WA.
Blood. 2015 Jan 22;125(4):606-15. doi: 10.1182/blood-2014-08-551994. Epub 2014 Nov 14.
Chronic graft-versus-host disease (GVHD) remains a common and potentially life-threatening complication of allogeneic hematopoietic stem cell transplantation (HCT). The 2-year cumulative incidence of chronic GVHD requiring systemic treatment is ~30% to 40% by National Institutes of Health criteria. The risk of chronic GVHD is higher and the duration of treatment is longer after HCT with mobilized blood cells than with marrow cells. Clinical manifestations can impair activities of daily living and often linger for years. Hematology and oncology specialists who refer patients to centers for HCT are often subsequently involved in the management of chronic GVHD when patients return to their care after HCT. Treatment of these patients can be optimized under shared care arrangements that enable referring physicians to manage long-term administration of immunosuppressive medications and supportive care with guidance from transplant center experts. Keys to successful collaborative management include early recognition in making the diagnosis of chronic GVHD, comprehensive evaluation at the onset and periodically during the course of the disease, prompt institution of systemic and topical treatment, appropriate monitoring of the response, calibration of treatment intensity over time in order to avoid overtreatment or undertreatment, and the use of supportive care to prevent complications and disability.
慢性移植物抗宿主病（GVHD）仍然是异基因造血干细胞移植（HCT）后一种常见且潜在危及生命的并发症。根据美国国立卫生研究院（NIH）的标准，慢性 GVHD 需要系统治疗的 2 年累积发生率约为 30%至 40%。与骨髓细胞相比，使用动员的血细胞进行 HCT 后，慢性 GVHD 的风险更高，治疗持续时间更长。临床表现会影响日常生活活动，且常常持续多年。将患者转介至 HCT 中心的血液科和肿瘤学专家在患者 HCT 后返回其治疗时，通常会参与慢性 GVHD 的管理。在共享护理安排下，治疗这些患者可以得到优化，使转诊医生能够管理免疫抑制药物的长期给药和支持性护理，并在移植中心专家的指导下进行。成功协作管理的关键包括在做出慢性 GVHD 诊断时及早识别、在疾病开始时和定期进行全面评估、及时开始全身和局部治疗、适当监测反应、随着时间的推移调整治疗强度以避免过度治疗或治疗不足，以及使用支持性护理来预防并发症和残疾。
