1 Department of Respiratory Medicine, The Fifth People's Hospital of Suzhou, Suzhou, China.
2 The Affiliated Infectious Diseases Hospital of Soochow University, Suzhou, China.
Stem Cells Dev. 2019 Jun 1;28(11):745-753. doi: 10.1089/scd.2018.0259. Epub 2019 May 20.
Our previous studies demonstrated promising outcomes after haploidentical donor transplant combined with unrelated umbilical cord blood (haplo-cord- hematopoietic stem cell transplantation [HSCT]) for hematological disorders. However, clinical profiling regarding chronic graft-versus-host disease (cGVHD) has not yet been fully described under this protocol. This study analyzed the clinical characteristics of cGVHD among 300 patients with hematological malignancies who received haplo-cord-HSCT between January 2012 and July 2016 at our center. During the follow-up, the 5-year cumulative incidence of cGVHD based on the National Institutes of Health (NIH) consensus criteria was 32.2% (95% confidence interval [CI], 28.7-35.7); the 5-year cumulative incidence of moderate to severe cGVHD was 11.4% (95% CI, 9.4-13.4). After the multivariate analysis, the GVHD overall survival (GOS) was associated with relapse, thrombocytopenia, bronchiolitis obliterans syndrome, and steroid-refractory cGVHD. The infused CD34 cells (≥3.46 × 10/kg) from haploidentical grafts were a protective factor affecting GOS. This study proposed a nomogram for predicting GOS using the aforementioned five variables. The concordance index was 0.877 (95% CI, 0.859-0.895) for the accuracy evaluation of the nomogram. Our results suggested that the 5-year cumulative incidence of NIH-defined cGVHD after haplo-cord-HSCT was 32.2%, and this nomogram may help clinicians select reasonable treatment strategies.
我们之前的研究表明，在同种异体供体移植联合无关脐血（半相合-脐带血-造血干细胞移植[HSCT]）治疗血液系统疾病后，具有良好的疗效。然而，该方案下慢性移植物抗宿主病（cGVHD）的临床特征尚未得到充分描述。本研究分析了 2012 年 1 月至 2016 年 7 月期间在我中心接受半相合-脐带血-HSCT 的 300 例血液系统恶性肿瘤患者的 cGVHD 临床特征。在随访期间，根据美国国立卫生研究院（NIH）共识标准，cGVHD 的 5 年累积发生率为 32.2%（95%置信区间[CI]，28.7-35.7）；5 年中重度 cGVHD 的累积发生率为 11.4%（95% CI，9.4-13.4）。多变量分析后，GVHD 总生存（GOS）与复发、血小板减少、闭塞性细支气管炎综合征和激素难治性 cGVHD 相关。来自半相合移植物的输注 CD34 细胞（≥3.46×10/kg）是影响 GOS 的保护因素。本研究提出了一个使用上述五个变量预测 GOS 的列线图。该列线图的准确性评估的一致性指数为 0.877（95% CI，0.859-0.895）。我们的研究结果表明，半相合-脐带血-HSCT 后 NIH 定义的 cGVHD 的 5 年累积发生率为 32.2%，该列线图可能有助于临床医生选择合理的治疗策略。
