Shimomura Yoshimitsu, Kitamura Tetsuhisa, Murata Makoto, Matsuo Keitaro, Ito Yuri, Ichinohe Tatsuo, Hashii Yoshiko, Goto Hideki, Kato Koji, Ishimaru Fumihiko, Sato Atsushi, Onizuka Makoto, Yanagisawa Atsumi, Ohbiki Marie, Tabuchi Ken, Atsuta Yoshiko, Fukuda Takahiro, Kanda Junya, Terakura Seitaro
Department of Hematology, Kobe City Hospital Organization Kobe City Medical Center General Hospital, Chuo-ku, Kobe, Japan; Department of Environmental Medicine and Population Science, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan.
Department of Environmental Medicine and Population Science, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan.
Transplant Cell Ther. 2024 Mar;30(3):326.e1-326.e14. doi: 10.1016/j.jtct.2024.01.056. Epub 2024 Jan 11.
Chronic graft-versus-host disease (cGVHD) is a complication of allogeneic hematopoietic stem cell transplantation (HSCT), negatively impacting quality of life (QoL) and increasing the risk of death. Complexity in cGVHD diagnosis and treatment causes significant variations in cGVHD management strategies across medical centers and physicians despite the existence of published guidelines. Thus, we hypothesized that center volume is associated with cGVHD incidence and outcomes after cGVHD develops. This study aimed to evaluate the effect of center volume on the incidence of cGVHD in patients who underwent HSCT and outcomes in patients with cGVHD. Our retrospective study included 28,786 patients who underwent their first HSCT (overall cohort) and 7664 who developed cGVHD (cGVHD cohort). We categorized institutions into quartiles (very low, low, high, and very high) using the number of HSCTs performed during the study period. We assessed cGVHD incidence in overall cohort and overall survival (OS) in cGVHD cohort. The very high-volume group showed significantly higher cGVHD incidence (adjusted hazard ratio [HR], 1.38; 95% confidence interval [CI]: 1.30 to 1.46) compared to the very low-volume group. However, the cGVHD incidence was similar among very low-, low- and high-volume groups. Low, high, and very high-volume groups showed significantly higher OS with adjusted HRs of 0.83 (95% CI: 0.73 to 0.94), 0.69 (95% CI: 0.61 to 0.79), and 0.68 (95% CI: 0.60 to 0.76), respectively, compared with the very low-volume group. In conclusion, we revealed a higher incidence of cGVHD in the very high-volume group and a poor survival outcome in the very low-volume group in patients with cGVHD.
慢性移植物抗宿主病（cGVHD）是异基因造血干细胞移植（HSCT）的一种并发症，对生活质量（QoL）产生负面影响，并增加死亡风险。尽管有已发表的指南，但cGVHD诊断和治疗的复杂性导致各医疗中心和医生在cGVHD管理策略上存在显著差异。因此，我们推测中心规模与cGVHD发病率以及cGVHD发生后的结局相关。本研究旨在评估中心规模对接受HSCT患者的cGVHD发病率以及cGVHD患者结局的影响。我们的回顾性研究纳入了28786例接受首次HSCT的患者（总体队列）和7664例发生cGVHD的患者（cGVHD队列）。我们根据研究期间进行的HSCT数量将机构分为四分位数（极低、低、高和极高）。我们评估了总体队列中的cGVHD发病率以及cGVHD队列中的总生存期（OS）。与极低规模组相比，极高规模组的cGVHD发病率显著更高（调整后的风险比[HR]为1.38；95%置信区间[CI]：1.30至1.46）。然而，极低、低和高规模组之间的cGVHD发病率相似。与极低规模组相比，低、高和极高规模组的OS显著更高，调整后的HR分别为0.83（95%CI：0.73至0.94）、0.69（95%CI：0.61至0.79）和0.68（95%CI：0.60至0.76）。总之，我们发现cGVHD患者中，极高规模组的cGVHD发病率更高，而极低规模组的生存结局较差。
