Shimomura Yoshimitsu, Terakura Seitaro, Matsuo Keitaro, Ito Yuri, Ichinohe Tatsuo, Hashii Yoshiko, Goto Hideki, Kato Koji, Kawamura Koji, Onizuka Makoto, Ishimaru Fumihiko, Takahashi Yoshiyuki, Yanagisawa Atsumi, Ohbiki Marie, Tabuchi Ken, Atsuta Yoshiko, Fukuda Takahiro, Kanda Junya, Murata Makoto
Department of Hematology, Kobe City Hospital Organization Kobe City Medical Center General Hospital, Minamimati 2-1-1, Minatojima, Chuo-ku, Kobe, 650-0047, Japan.
Department of Environmental Medicine and Population Science, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan.
Int J Hematol. 2025 May 20. doi: 10.1007/s12185-025-04003-2.
Prophylactic, diagnostic, and treatment strategies for acute graft-versus-host disease (aGVHD) may vary across medical centers and physicians. We aimed to investigate the relationship between center volume and the incidence and outcomes of aGVHD. This retrospective study included 28,786 patients who underwent their first hematopoietic stem cell transplantation (HSCT) (entire cohort) and 9498 patients who developed grade II-IV aGVHD (aGVHD cohort). Data were categorized into quartiles (very low, low, high, and very high) based on the number of HSCTs the treating center performed during the study period. We assessed the incidence of aGVHD using the entire cohort and overall survival (OS) using the aGVHD cohort. Higher center volume was associated with a higher incidence of grade II-IV aGVHD than very low center volume, with an adjusted hazard ratio of 1.07-1.11. Conversely, center volume was not associated with the incidence of grade III-IV aGVHD. OS after development of aGVHD was better in the higher center volume group than the very low-volume group, with an adjusted hazard ratio of 0.81-0.89. A very low-volume center was associated with a lower incidence of grade II-IV aGVHD in patients with allogeneic HSCT and poor survival in patients with aGVHD.
急性移植物抗宿主病（aGVHD）的预防、诊断和治疗策略在不同医疗中心和医生之间可能存在差异。我们旨在研究中心工作量与aGVHD的发病率及预后之间的关系。这项回顾性研究纳入了28786例接受首次造血干细胞移植（HSCT）的患者（整个队列）以及9498例发生II-IV级aGVHD的患者（aGVHD队列）。根据研究期间治疗中心进行HSCT的数量，将数据分为四分位数（极低、低、高和极高）。我们使用整个队列评估aGVHD的发病率，使用aGVHD队列评估总生存期（OS）。与极低中心工作量相比，较高的中心工作量与II-IV级aGVHD的较高发病率相关，调整后的风险比为1.07-1.11。相反，中心工作量与III-IV级aGVHD的发病率无关。aGVHD发生后的OS在较高中心工作量组中优于极低工作量组，调整后的风险比为0.81-0.89。极低工作量中心与异基因HSCT患者中II-IV级aGVHD的较低发病率以及aGVHD患者的较差生存率相关。
