Division of Hematology and Program of HSC Transplantation - Policlinico di Catania, 95124, Catania, Italy.
Bone Marrow Transplant. 2024 Jan;59(1):17-22. doi: 10.1038/s41409-023-02107-z. Epub 2023 Sep 25.
We conducted a prospective study aimed at investigating the prognostic value of the dynamic of a-GVHD progression from cutaneous to visceral involvement. In 108 consecutive patients who underwent allogeneic HSCT, we classified a-GVHD according to a "GHVD skin dynamic": 18/82 patients started Corticosteroid (CS) within 48 h (Group 1); 13/82 started CS within days 3-7 (Group 2); Group 3A (n 31) was defined when Skin GVHD Overall Grade 1, left untreated for 1 week, showed an increase in involved body surface area <5 %; Group 3B (n 20), was defined when Skin GVHD Overall Grade 1, left untreated at 1 week, had an increase in involved body surface area >5%. These four groups had distinctive 2-y OS. Patients could be then grouped into "poor risk" (Group 1 and Group 3B) and "good risk" (Group 2 and Group 3A). "Poor risk" had inferior OS in univariate and multivariate analysis, (HR 2.222; 95% CL: 1.017-4.855; p 0.04). Among the patients with skin-only Grade 1 GVHD, subgroup 3A had an OS of 75.1% versus 39.8% found in subgroup 3B (p = 0.03). The dynamic of skin GVHD may be used to classify a-GVHD and guide treatment in Overall Grade 1 skin-only GVHD.
我们进行了一项前瞻性研究，旨在探讨从皮肤到内脏受累的急性移植物抗宿主病（a-GVHD）进展的动态变化对预后的预测价值。在 108 例接受异基因造血干细胞移植的连续患者中，我们根据“a-GVHD 皮肤动态变化”对 a-GVHD 进行分类：18/82 例患者在 48 小时内开始使用皮质类固醇（CS）（第 1 组）；13/82 例患者在第 3-7 天开始使用 CS（第 2 组）；第 3A 组（n=31）定义为皮肤 GVHD 总评分 1 级，未经治疗 1 周，受累体表面积增加<5%；第 3B 组（n=20）定义为皮肤 GVHD 总评分 1 级，未经治疗 1 周，受累体表面积增加>5%。这四个组具有不同的 2 年 OS。然后可以将患者分为“高危”（第 1 组和第 3B 组）和“低危”（第 2 组和第 3A 组）。在单因素和多因素分析中，“高危”患者的 OS 较差（HR 2.222；95%CL：1.017-4.855；p=0.04）。在仅皮肤 1 级 GVHD 的患者亚组中，第 3A 亚组的 OS 为 75.1%，而第 3B 亚组为 39.8%（p=0.03）。皮肤 GVHD 的动态变化可用于分类 a-GVHD，并指导仅皮肤 1 级 GVHD 的总体分级 1 级的治疗。
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