Eisner M D, August C S
Department of Pediatrics, Children's Hospital of Philadelphia, PA, USA.
Bone Marrow Transplant. 1995 May;15(5):663-8.
Current knowledge of risk factors for graft-versus-host disease (GVHD) in pediatric bone marrow transplantation is derived from studies focusing primarily on adults. We reviewed 100 pediatric HLA-matched allogeneic marrow transplants to identify donor and recipient factors (age, sex, age mismatch, sex mismatch) associated with increased incidence of acute or chronic GVHD. The incidence of acute (32%) and chronic (29%) GVHD were very low. In univariate analyses, recipient age (P = 0.003), donor age (P = 0.002), donor sex (P = 0.089) and age mismatch (P = 0.018) are related to acute GVHD. Prior acute GVHD (P = 0.0001), recipient age (P = 0.057), donor age (P = 0.016), donor sex (P = 0.01) and sex mismatch (P = 0.024) are associated with chronic GVHD. In multivariate analyses, older donor age (P = 0.003) and female donor sex (P = 0.046) independently predict acute GVHD. Only acute GVHD (P = 0.0001) was independently related to chronic GVHD. When acute GVHD was excluded, older donor age (P = 0.032) and sex mismatch (P = 0.005) predict chronic GVHD. Thus, the incidence of acute and chronic GVHD were very low in our pediatric population, especially in the youngest patients. Older donor age and female donor sex are associated with a higher incidence of acute GVHD. Prior acute GVHD, older donor age and sex mismatch are associated with a higher incidence of chronic GVHD.
目前关于儿童骨髓移植中移植物抗宿主病（GVHD）危险因素的知识主要来源于针对成人的研究。我们回顾了100例儿童 HLA 匹配的同种异体骨髓移植病例，以确定与急性或慢性 GVHD 发病率增加相关的供体和受体因素（年龄、性别、年龄不匹配、性别不匹配）。急性（32%）和慢性（29%）GVHD 的发病率非常低。在单因素分析中，受体年龄（P = 0.003）、供体年龄（P = 0.002）、供体性别（P = 0.089）和年龄不匹配（P = 0.018）与急性 GVHD 相关。既往急性 GVHD（P = 0.0001）、受体年龄（P = 0.057）、供体年龄（P = 0.016）、供体性别（P = 0.01）和性别不匹配（P = 0.024）与慢性 GVHD 相关。在多因素分析中，供体年龄较大（P = 0.003）和供体为女性（P = 0.046）独立预测急性 GVHD。只有急性 GVHD（P = 0.0001）与慢性 GVHD 独立相关。当排除急性 GVHD 时，供体年龄较大（P = 0.032）和性别不匹配（P = 0.005）预测慢性 GVHD。因此，在我们的儿童人群中，急性和慢性 GVHD 的发病率非常低，尤其是最年幼的患者。供体年龄较大和供体为女性与急性 GVHD 的较高发病率相关。既往急性 GVHD、供体年龄较大和性别不匹配与慢性 GVHD 的较高发病率相关。
