Arora Mukta, Cutler Corey S, Jagasia Madan H, Pidala Joseph, Chai Xiaoyu, Martin Paul J, Flowers Mary E D, Inamoto Yoshihiro, Chen George L, Wood William A, Khera Nandita, Palmer Jeanne, Duong Hien, Arai Sally, Mayer Sebastian, Pusic Iskra, Lee Stephanie J
Division of Hematology, Oncology and Transplant, University of Minnesota Medical School, Minneapolis, Minnesota.
Division of Hematologic Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts.
Biol Blood Marrow Transplant. 2016 Mar;22(3):449-55. doi: 10.1016/j.bbmt.2015.10.018. Epub 2015 Nov 2.
Several distinct graft-versus-host disease (GVHD)-related syndromes have been defined by the National Institutes of Health Consensus Conference. We enrolled a prospective cohort of 911 hematopoietic cell transplantation (HCT) recipients at 13 centers between March 2011 and May 2014 to evaluate 4 GVHD syndromes: late acute GVHD (aGVHD), chronic GVHD (cGVHD), bronchiolitis obliterans syndrome, and cutaneous sclerosis. The median age at HCT was 53.7 years. The majority of patients received a peripheral blood stem cell transplant (81%) following nonmyeloablative or reduced-intensity conditioning (55%). Pediatric age group and use of bone marrow and umbilical cord blood grafts were underrepresented in our cohort (≤11%). The cumulative incidence of late aGVHD (late onset and recurrent) was 10% at a median of 5.5 months post-HCT, that of cGVHD was 47% at a median of 7.4 months, that of bronchiolitis obliterans was 3% at a median of 12.2 months, and that of cutaneous sclerosis was 8% at a median onset of 14.0 months. Late aGVHD and bronchiolitis obliterans had particularly high nonrelapse mortality of 23% and 32%, respectively, by 2 years after diagnosis. The probability of late aGVHD- and cGVHD-free, relapse-free survival was 38% at 1 year post-HCT and 26% at 2 years post-HCT. This multicenter prospective study confirms the high rate of late aGVHD and cGVHD syndromes and supports the need for continuous close monitoring and development of more effective GVHD treatment strategies to improve HCT success.
美国国立卫生研究院共识会议已定义了几种不同的移植物抗宿主病(GVHD)相关综合征。我们在2011年3月至2014年5月期间,于13个中心纳入了911例造血细胞移植(HCT)受者的前瞻性队列,以评估4种GVHD综合征:晚期急性GVHD(aGVHD)、慢性GVHD(cGVHD)、闭塞性细支气管炎综合征和皮肤硬化症。HCT时的中位年龄为53.7岁。大多数患者在接受非清髓性或降低强度预处理(55%)后接受了外周血干细胞移植(81%)。我们的队列中儿童年龄组以及骨髓和脐带血移植物的使用比例较低(≤11%)。晚期aGVHD(迟发和复发)的累积发生率在HCT后中位5.5个月时为10%,cGVHD在中位7.4个月时为47%,闭塞性细支气管炎在中位12.2个月时为3%,皮肤硬化症在中位发病14.0个月时为8%。晚期aGVHD和闭塞性细支气管炎在诊断后2年时的非复发死亡率特别高,分别为23%和32%。无晚期aGVHD和cGVHD、无复发存活的概率在HCT后1年时为38%,在HCT后2年时为26%。这项多中心前瞻性研究证实了晚期aGVHD和cGVHD综合征的高发生率,并支持需要持续密切监测以及制定更有效的GVHD治疗策略以提高HCT的成功率。