异基因造血干细胞移植后侵袭性真菌病与慢性移植物抗宿主病相关：一项单中心回顾性研究。
Invasive fungal disease is associated with chronic graft-versus-host disease after allogeneic hematopoietic stem cell transplant: a single center, retrospective study.
机构信息
Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, China.
Guangdong Provincial Key Laboratory of Construction and Detection in Tissue Engineering, Southern Medical University, Guangdong, China.
出版信息
Infection. 2019 Apr;47(2):275-284. doi: 10.1007/s15010-018-01265-3. Epub 2019 Feb 7.
BACKGROUND
Invasive fungal disease (IFD) and graft-versus-host disease (GVHD) are major causes of morbidity and mortality after allogeneic hematopoietic stem cell transplantation (allo-HSCT). However, the impacts of IFD on chronic GVHD remain unknown.
METHODS
We conducted a retrospective study of 510 patients with hematologic malignancy undergoing allo-HSCT to explore the effects of IFD on chronic GVHD.
RESULTS
The 2-year cumulative incidences of overall (limited and extensive) and extensive chronic GVHD post-transplantation were higher in patients with IFD compared with those without IFD (69.5% ± 4.2% versus 32.9% ± 2.4%, P < .001; 43.0% ± 5.2% versus 6.6% ± 1.4%, P < .001, respectively). Moreover, the patients with IFD had higher 5-year transplant-related mortality, lower 5-year overall survival and lower 5-year disease-free survival (29.8% ± 4.3% versus 9.8% ± 1.6%, P < .001; 50.5% ± 4.9% versus 71.3% ± 2.4%, P < .001 and 48.8% ± 4.7% versus 71.8% ± 2.3%, P < .001, respectively). Multivariable analyses demonstrated that IFD increased the risk of chronic GVHD.
CONCLUSION
Our results suggest that IFD significantly contributes to the development of chronic GVHD after allo-HSCT.
背景
侵袭性真菌病（IFD）和移植物抗宿主病（GVHD）是异基因造血干细胞移植（allo-HSCT）后发病率和死亡率的主要原因。然而，IFD 对慢性 GVHD 的影响尚不清楚。
方法
我们对 510 例接受 allo-HSCT 的血液系统恶性肿瘤患者进行了回顾性研究，以探讨 IFD 对慢性 GVHD 的影响。
结果
IFD 组患者移植后 2 年总体（局限性和广泛性）和广泛性慢性 GVHD 的累积发生率高于无 IFD 组（69.5%±4.2%比 32.9%±2.4%，P<0.001；43.0%±5.2%比 6.6%±1.4%，P<0.001）。此外，IFD 组患者 5 年移植相关死亡率较高，总生存率和无病生存率较低（29.8%±4.3%比 9.8%±1.6%，P<0.001；50.5%±4.9%比 71.3%±2.4%，P<0.001 和 48.8%±4.7%比 71.8%±2.3%，P<0.001）。多变量分析表明，IFD 增加了慢性 GVHD 的风险。
结论
我们的研究结果表明，IFD 显著增加 allo-HSCT 后慢性 GVHD 的发生风险。
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