30年来慢性移植物抗宿主病的发展趋势——欧洲血液与骨髓移植协会移植并发症工作组的一项研究
Chronic Graft-versus-Host disease trends over 30 years - a study by the EBMT transplant complications working party.
作者信息
Pulanic Drazen, Peczynski Christophe, Boreland William, Rautenberg Christina, Kröger Nicolaus, Michonneau David, Salmenniemi Urpu, Zeiser Robert, Egger-Heidrich Katharina, Forcade Edouard, Blaise Didier, Luft Thomas, Labussière-Wallet Hélène, Moiseev Ivan, Koenecke Christian, Schoemans Helene, Basak Grzegorz, Penack Olaf, Peric Zinaida
机构信息
Division of Hematology, Department of Internal Medicine, University Hospital Center, Zagreb, Croatia.
University of Zagreb, School of Medicine, Zagreb, Croatia.
出版信息
Bone Marrow Transplant. 2025 Aug 19. doi: 10.1038/s41409-025-02697-w.
We assessed whether the incidence and outcomes of chronic Graft-versus-Host Disease (cGvHD) after allogeneic hematopoietic stem cell transplantation (alloHSCT) have changed over 30 years. We studied 102,275 adults with hematological malignancies receiving a first alloHSCT from identical siblings or unrelated donors. We compared 3 decades: (I) 1990-1999 vs. (II) 2000-2009 vs. (III) 2010-2019. Over time, patients were older at transplantation, received more PBSC, unrelated donor transplants, reduced intensity conditioning, in vivo T-cell depletion and an ATG prophylaxis, and less TBI. cGvHD incidence at 48 months was 37.3% [36.2-38.4] in I decade vs. 44.9% [44.3-45.5] in II decade vs. 39.1% [38.7-39.5] in III decade, and incidence of extensive cGvHD at 48 months was 18.1% [17.3-19] vs. 22.2% [21.7-22.6] vs. 19.2% [18.9-19.5] over decades. In multivariate analysis, more cGvHD developed in II than in I decade (HR 1.14, 95% CI 1.09-1.21), but no difference was found between III and I decade (HR 1.01, 95% CI 0.96-1.06). Among patients with cGvHD, NRM at 48 months decreased over decades (21.3% [19.8-22.8] vs. 21% [20.3-21.7] vs. 19.7% [19.1-20.2], p < 0.001). Our data show unchanged cGvHD incidences over time and a high NRM in patients after cGvHD diagnosis.
我们评估了异基因造血干细胞移植（alloHSCT）后慢性移植物抗宿主病（cGvHD）的发病率和转归在30年期间是否发生了变化。我们研究了102,275例患有血液系统恶性肿瘤的成人患者，他们接受了来自同卵同胞或无关供者的首次alloHSCT。我们比较了三个十年：（I）1990 - 1999年与（II）2000 - 2009年与（III）2010 - 2019年。随着时间的推移，患者移植时年龄更大，接受了更多的外周血干细胞（PBSC）、无关供者移植、减低强度预处理、体内T细胞清除和抗胸腺细胞球蛋白（ATG）预防，且接受全身照射（TBI）的较少。在第一个十年中，48个月时cGvHD的发病率为37.3% [36.2 - 38.4]，第二个十年为44.9% [44.3 - 45.5]，第三个十年为39.1% [38.7 - 39.5]；数十年间48个月时广泛cGvHD的发病率分别为18.1% [17.3 - 19]、22.2% [21.7 - 22.6]和19.2% [18.9 - 19.5]。在多变量分析中，第二个十年发生cGvHD的患者比第一个十年更多（风险比[HR] 1.14，95%置信区间[CI] 1.09 - 1.21），但第三个十年与第一个十年之间未发现差异（HR 1.01，95% CI 0.96 - 1.06）。在患有cGvHD的患者中，48个月时的非复发死亡率（NRM）在数十年间有所下降（21.3% [19.8 - 22.8]、21% [20.3 - 21.7]、19.7% [19.1 - 20.2]，p < 0.001）。我们的数据显示，随着时间的推移cGvHD发病率未变，且cGvHD诊断后患者的NRM较高。
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