Langer Ronja, Lelas Antonela, Rittenschober Michael, Piekarska Agnieszka, Sadowska-Klasa Alicja, Sabol Ivan, Desnica Lana, Greinix Hildegard, Dickinson Anne, Inngjerdingen Marit, Lawitschka Anita, Vrhovac Radovan, Pulanic Drazen, Güneş Sibel, Klein Stefan, Moritz Middeke Jan, Grube Matthias, Edinger Matthias, Herr Wolfgang, Wolff Daniel
Department of Internal Medicine III, Hematology and Oncology, University Hospital Regensburg, Regensburg, Germany.
Division of Hematology, Department of Internal Medicine, University Hospital Centre Zagreb, Zagreb, Croatia.
Front Transplant. 2024 Mar 18;3:1332181. doi: 10.3389/frtra.2024.1332181. eCollection 2024.
Chronic graft-versus-host disease (cGvHD) is a serious late complication of allogeneic hematopoietic stem cell transplantation (allo-HSCT).
This multicenter analysis determined the cumulative incidence (CI) of cGvHD and late acute GvHD (laGvHD) and its impact on transplantation-related mortality (TRM), relapse (R), and overall survival (OS) in 317 patients [296 adults, 21 pediatrics (<12 years of age)] who underwent their first allo-HSCT in 2017.
The CI of laGvHD was 10.5% in adults and 4.8% in pediatrics, and the CI of cGvHD was 43.0% in all adult transplant patients and 50.2% in the adult at-risk cohort at the study end. The onset of cGvHD was in 42.0% of patients, quiescent in 52.1%, and progressive in 5.9%. In adults, prophylactic use of antithymocyte globulin or posttransplant cyclophosphamide was associated with a significantly lower incidence of cGvHD (28.7%) vs. standard prophylaxis with calcineurin inhibitors (30.6%) and methotrexate/mycophenolate mofetil (58.4%) (all < 0.01). TRM was significantly higher in patients with aGvHD (31.8%) vs. cGvHD (12.6%) and no GvHD (6.3%) (all = 0.0001). OS in the adult at-risk cohort was significantly higher in patients with cGvHD (78.9%) vs. without (66.2%; = 0.0022; HR 0.48) due to a significantly lower relapse rate (cGvHD: 14.5%; without cGvHD: 27.2%; = 0.00016, HR 0.41). OS was also significantly higher in patients with mild (80.0%) and moderate (79.2%) cGvHD vs. without cGvHD (66.2%), excluding severe cGvHD (72.7%) (all = 0.0214).
The negative impact of severe cGvHD on OS suggests a focus on prevention of severe forms is warranted to improve survival and quality of life.
慢性移植物抗宿主病（cGvHD）是异基因造血干细胞移植（allo-HSCT）的一种严重晚期并发症。
这项多中心分析确定了2017年接受首次allo-HSCT的317例患者[296例成人，21例儿科患者（<12岁）]中cGvHD和晚期急性移植物抗宿主病（laGvHD）的累积发病率（CI）及其对移植相关死亡率（TRM）、复发（R）和总生存期（OS）的影响。
laGvHD的CI在成人中为10.5%，在儿科患者中为4.8%，cGvHD的CI在所有成人移植患者中为43.0%，在研究结束时的成人高危队列中为50.2%。42.0%的患者cGvHD发病，52.1%处于静止期，5.9%为进展期。在成人中，预防性使用抗胸腺细胞球蛋白或移植后环磷酰胺与cGvHD的发病率显著低于使用钙调神经磷酸酶抑制剂（30.6%）和甲氨蝶呤/霉酚酸酯（58.4%）的标准预防措施（均<0.01）。急性移植物抗宿主病（aGvHD）患者的TRM（31.8%）显著高于cGvHD患者（12.6%）和无移植物抗宿主病患者（6.3%）（均=0.0001）。由于复发率显著降低（cGvHD：14.5%；无cGvHD：27.2%；=0.00016，HR 0.41），成人高危队列中cGvHD患者的OS（78.9%）显著高于无cGvHD患者（66.2%；=0.0022；HR 0.48）。轻度（80.0%）和中度（79.2%）cGvHD患者的OS也显著高于无cGvHD患者（66.2%），不包括重度cGvHD患者（72.7%）（均=0.0214）。
重度cGvHD对OS的负面影响表明，有必要关注预防重度形式以提高生存率和生活质量。
