Gratwohl A, Hermans J, Apperley J, Arcese W, Bacigalupo A, Bandini G, di Bartolomeo P, Boogaerts M, Bosi A, Carreras E
Department of Research, Kantonsspital Basel, Switzerland.
Blood. 1995 Jul 15;86(2):813-8.
Acute graft-versus-host disease (aGVHD) has been classified according to the Seattle criteria as grades 0, I, II, III, and IV for 20 years. The predictive value of such detailed grading is a matter of debate; publications usually report GVHD as present or absent or as absent, moderate, or severe. The Working Party Chronic Leukemia of the European Group for Bone Marrow Transplantation analyzed data of 1,294 patients transplanted from an allogeneic donor for chronic myelogenous leukemia (CML) in first chronic phase and tested the predictive value of aGVHD grading for the following end-points: day 100 mortality (D100M), transplant-related mortality (TRM), relapse incidence (RI), leukemia-free survival (LFS), and survival (SURV). aGVHD was absent in 462 patients (35.7%), grade I occurred in 335 (25.8%), grade II in 264 (20.5%), grade III in 110 (8.5%), and grade IV in 123 patients (9.5%). A total of 297 patients (23%) died within 100 days, 495 patients (38%) died of any TRM, and 100 patients (8%) died of relapse. D100M according to grades 0, I, II, III, and IV was 17%, 13%, 19%, 38%, and 70%, respectively, with significant difference between 0-II versus III-IV. TRM was 28%, 27%, 43%, 68%, and 92%, respectively, with a distinct separation between 0-I versus II-IV. RI showed a continuous decrease of 37%, 30%, 23%, 18%, and 8%, respectively, with increasing aGVHD. LFS was 45%, 51%, 44%, 26%, and 7%, respectively, and was best for patients with grade I aGVHD. This finding was also reflected in a better overall survival (60%, 64%, 53%, 30%, and 8%, respectively). The better LFS for grade I aGVHD patients compared with patients with grade 0 or II aGVHD was confirmed (P = .05) in a multivariate analysis. These data document the value of the present 5-point grading of aGVHD, ie, different outcome is observed depending on endpoint analyzed. Restricting information about aGVHD to presence or absence is not warranted.
20年来，急性移植物抗宿主病（aGVHD）一直按照西雅图标准分为0、I、II、III和IV级。这种详细分级的预测价值存在争议；出版物通常报告移植物抗宿主病为存在或不存在，或为不存在、中度或重度。欧洲骨髓移植组慢性白血病工作组分析了1294例在慢性期首次接受异基因供体移植治疗慢性粒细胞白血病（CML）患者的数据，并测试了aGVHD分级对以下终点的预测价值：第100天死亡率（D100M）、移植相关死亡率（TRM）、复发率（RI）、无白血病生存率（LFS）和总生存率（SURV）。462例患者（35.7%）无aGVHD，335例（25.8%）发生I级aGVHD，264例（20.5%）发生II级aGVHD，110例（8.5%）发生III级aGVHD，123例患者（9.5%）发生IV级aGVHD。共有297例患者（23%）在100天内死亡，495例患者（38%）死于任何移植相关并发症，100例患者（8%）死于复发。0、I、II、III和IV级的D100M分别为17%、13%、19%、38%和70%，0-II级与III-IV级之间存在显著差异。TRM分别为28%、27%、43%、68%和92%，0-I级与II-IV级之间有明显区分。RI随着aGVHD的增加分别持续下降37%、30%、23%、18%和8%。LFS分别为45%、51%、44%、26%和7%，I级aGVHD患者的LFS最佳。这一发现也反映在更好的总生存率上（分别为60%、64%、53%、30%和8%）。多因素分析证实，I级aGVHD患者的LFS优于0级或II级aGVHD患者（P = 0.05）。这些数据证明了目前aGVHD的5级分级的价值，即根据分析的终点观察到不同的结果。将移植物抗宿主病的信息限制为存在或不存在是不合理的。
