Storb R, Prentice R L, Buckner C D, Clift R A, Appelbaum F, Deeg J, Doney K, Hansen J A, Mason M, Sanders J E, Singer J, Sullivan K M, Witherspoon R P, Thomas E D
N Engl J Med. 1983 Feb 10;308(6):302-7. doi: 10.1056/NEJM198302103080602.
One hundred thirty patients with severe aplastic anemia were conditioned with cyclophosphamide for transplantation of marrow from HLA-identical siblings. The patients were selected for the present analysis according to the criterion of sustained marrow engraftment. Of the 130 patients, 97 are now alive between 1.4 and 11 years (median, 5) after transplantation. Twenty-nine of the thirty-three who died had either acute or chronic graft-versus-host disease (GVHD). Our analysis was directed at identifying factors predicting GVHD and survival after transplantation in patients. Our key findings were that moderately severe to severe acute GVHD had a strong adverse influence on survival; that a protective environment significantly reduced mortality, which corresponded in part to a reduction in and delayed onset of acute GVHD; that refractoriness to random-donor platelet infusions at transplantation adversely influenced survival, particularly among patients with acute GVHD; and that increasing age was associated with increased mortality.
130例重型再生障碍性贫血患者接受环磷酰胺预处理，以进行来自人类白细胞抗原（HLA）相合同胞的骨髓移植。根据持续骨髓植入的标准选择患者进行本次分析。130例患者中，97例在移植后1.4至11年（中位数为5年）存活。死亡的33例患者中有29例发生了急性或慢性移植物抗宿主病（GVHD）。我们的分析旨在确定预测患者移植后GVHD和生存的因素。我们的主要发现是，中度至重度急性GVHD对生存有强烈的不利影响；保护性环境显著降低死亡率，这部分对应于急性GVHD的减少和延迟发作；移植时对随机供体血小板输注的难治性对生存有不利影响，尤其是在急性GVHD患者中；并且年龄增加与死亡率增加相关。
