Punatar Sachin, Gupta Alok, Gawande Jayant, Bagal Bhausaheb, Mathew Libin, Kannan Sadhana, Khattry Navin
Bone Marrow Transplant Unit, Department of Medical Oncology, ACTREC, Tata Memorial Centre, Mumbai, 410210 India.
Department of Biostatistics, ACTREC, Tata Memorial Centre, Mumbai, 410210 India.
Indian J Hematol Blood Transfus. 2016 Mar;32(1):32-8. doi: 10.1007/s12288-015-0506-5. Epub 2015 Jan 20.
Chronic graft versus host disease (cGVHD) is a common late complication of allogenic hematopoietic stem cell transplant (HSCT). We analyzed risk factors, pattern and long term transplant outcomes of cGVHD at a tertiary cancer centre. Seventy-seven consecutive patients who underwent HSCT for acute leukemia were included. Forty (52 %) patients developed cGVHD; 24 (60 %) extensive stage while 16 (40 %) limited stage. Oral cavity was the commonest site of involvement (25 patients) followed by liver, skin and lung. We found that female donor to male recipient transplant and diagnosis of acute lymphoblastic leukemia (ALL) were the only factors associated with increased risk of cGVHD. The incidence of leukemia relapse was 18 % in patients who developed cGVHD compared to 51 % in those who did not (P = 0.002). Four year overall survival and relapse free survival (RFS) were 62 and 46 % in patients who developed cGVHD compared to 29 % (P < 0.001) and 29 % (P < 0.001) in patients who did not develop cGVHD, respectively. We conclude that cGVHD is more common in male patients with female donors and in patients transplanted for ALL. Oral cavity is the commonest site of cGVHD in our patients and transplant related survival outcomes are superior in patients who develop cGVHD.
慢性移植物抗宿主病（cGVHD）是异基因造血干细胞移植（HSCT）常见的晚期并发症。我们在一家三级癌症中心分析了cGVHD的危险因素、模式及长期移植结局。纳入了77例因急性白血病接受HSCT的连续患者。40例（52%）患者发生了cGVHD；24例（60%）为广泛期，16例（40%）为局限期。口腔是最常受累部位（25例患者），其次是肝脏、皮肤和肺。我们发现女性供体至男性受体移植以及急性淋巴细胞白血病（ALL）的诊断是与cGVHD风险增加相关的仅有的因素。发生cGVHD的患者白血病复发率为18%，而未发生cGVHD的患者为51%（P = 0.002）。发生cGVHD的患者4年总生存率和无复发生存率（RFS）分别为62%和46%，而未发生cGVHD的患者分别为29%（P < 0.001）和29%（P < 0.001）。我们得出结论，cGVHD在女性供体的男性患者以及接受ALL移植的患者中更为常见。在我们的患者中，口腔是cGVHD最常见的部位，并且发生cGVHD的患者移植相关生存结局更佳。
