Gale R P, Bortin M M, van Bekkum D W, Biggs J C, Dicke K A, Gluckman E, Good R A, Hoffmann R G, Kay H E, Kersey J H
Division of Hematology/Oncology, UCLA Center for the Health Sciences.
Br J Haematol. 1987 Dec;67(4):397-406. doi: 10.1111/j.1365-2141.1987.tb06160.x.
Acute graft-versus-host disease (GvHD) is an important complication of bone marrow transplantation in humans. Risk factors are imprecisely defined and controversial. We analysed data from 2036 recipients of HLA-identical sibling transplants for leukaemia or aplastic anaemia to identify risk factors for GvHD. Analyses indicate that grading of GvHD can be reproducibly divided into absent or mild versus moderate to severe; 2-year actuarial probability was 54% (95% confidence interval 52-56%) for absent or mild and 46% (44-48%) for moderate to severe. Factors predictive of development of moderate to severe GvHD include donor/recipient sex-match (female----male greater than others, relative risk 2.0, P less than 0.001). This risk was markedly increased if female donors for male recipients were previously pregnant or transfused (relative risk 2.9, P less than 0.0001). Older patients were at increased risk of GvHD (relative risk 1.6, P less than 0.001), but the age gradient was modest, even the youngest patients had a substantial risk of GvHD and, if parous or transfused female----male transplants were excluded, age was not a significant risk factor. Cyclosporine or methotrexate were equally effective at preventing GvHD and were superior to no prophylaxis (relative risk 2.3, P less than 0.01). These data should be useful in estimating the risk of acute GvHD in an individual patient and in designing clinical trials to investigate methods to modify or prevent GvHD.
急性移植物抗宿主病（GvHD）是人类骨髓移植的一种重要并发症。其危险因素定义不明确且存在争议。我们分析了2036例接受HLA相同同胞移植治疗白血病或再生障碍性贫血患者的数据，以确定GvHD的危险因素。分析表明，GvHD的分级可重复性地分为无或轻度与中度至重度；无或轻度的2年精算概率为54%（95%置信区间52 - 56%），中度至重度为46%（44 - 48%）。预测中度至重度GvHD发生的因素包括供体/受体性别匹配（女性供体至男性受体大于其他情况，相对风险2.0，P < 0.001）。如果男性受体的女性供体既往有过妊娠或输血史，这种风险会显著增加（相对风险2.9，P < 0.0001）。老年患者发生GvHD的风险增加（相对风险1.6，P < 0.001），但年龄梯度较小，即使是最年轻的患者也有相当大的GvHD风险，并且如果排除经产或输血的女性供体至男性受体的移植情况，年龄就不是一个显著的危险因素。环孢素或甲氨蝶呤在预防GvHD方面同样有效，且优于不进行预防（相对风险2.3，P < 0.01）。这些数据有助于评估个体患者发生急性GvHD的风险，并有助于设计临床试验来研究改变或预防GvHD的方法。
