Niederwieser D, Pepe M, Storb R, Witherspoon R, Longton G, Sullivan K
Fred Hutchinson Cancer Research Center, Seattle, WA 98104.
Bone Marrow Transplant. 1989 Mar;4(2):151-6.
The cumulative incidence of chronic graft-versus-host disease (GVHD) was 48% among 165 patients with severe aplastic anemia who had been discharged from Seattle 3 months after they were treated with marrow grafts from HLA-identical siblings. Estimated 10-year survival was 85%. Preceding acute GVHD had a dominating influence on the development of chronic GVHD. Almost all patients with grades II-IV and 67% of those with grade I acute GVHD developed chronic GVHD. Among patients without previous acute GVHD, three factors were independently correlated with an increased risk of de novo chronic GVHD: increasing patient age, the infusion of buffy coat cells in addition to the marrow, and corticosteroid therapy before transplantation. For example, patients below and above age 20 years who had neither buffy coat cell transfusions nor preceding corticosteroid therapy had an incidence of chronic GVHD of only 4-8%, while those with either buffy coat cell transfusions or corticosteroids or both had incidence rates of 33-70%. The development of chronic GVHD significantly influenced survival. Among 83 patients without chronic GVHD, only one died (on day 150 with interstitial pneumonia), compared to 23 deaths among 82 patients with chronic GVHD. For results of marrow grafting for aplastic anemia to improve, better prevention of chronic GVHD is needed.
165例严重再生障碍性贫血患者接受来自 HLA 配型相同同胞的骨髓移植治疗3个月后从西雅图出院，慢性移植物抗宿主病（GVHD）的累积发病率为48%。估计10年生存率为85%。既往急性 GVHD 对慢性 GVHD 的发生有主导影响。几乎所有 II-IV 级急性 GVHD 患者以及67%的 I 级急性 GVHD 患者发生了慢性 GVHD。在既往无急性 GVHD 的患者中，三个因素与新发慢性 GVHD 的风险增加独立相关：患者年龄增加、除骨髓外输注富含白细胞层细胞以及移植前使用皮质类固醇治疗。例如，年龄在20岁以下且既未输注富含白细胞层细胞也未接受过皮质类固醇治疗的患者，慢性 GVHD 的发生率仅为4-8%，而接受过富含白细胞层细胞输注或皮质类固醇治疗或两者皆有的患者，发生率为33-70%。慢性 GVHD 的发生显著影响生存率。在83例无慢性 GVHD 的患者中，仅有1例死亡（于第150天死于间质性肺炎），而82例有慢性 GVHD 的患者中有23例死亡。为了改善再生障碍性贫血的骨髓移植结果，需要更好地预防慢性 GVHD。
